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Zhou D, Xu R, Liu Y, Yang Y, Wu Z, Luo Y, Zeng S. Left Ventricular Vortex Characteristics in Fetuses With Coarctation of the Aorta by Blood Speckle-Tracking Echocardiography. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2024; 43:841-849. [PMID: 38240409 DOI: 10.1002/jum.16412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/09/2023] [Revised: 12/02/2023] [Accepted: 12/27/2023] [Indexed: 04/18/2024]
Abstract
OBJECTIVES The aims of this study were to assess the vortex characteristics of left ventricle (LV) in fetuses with coarctation of the aorta (CoA) using high-frame rate ultrasound with blood speckle-tracking (BST) and explore its relationships with cardiac function and morphology parameters. METHODS Thirty fetuses with CoA and 30 gestational-age matched normal fetuses were included in this cross-sectional study. The area, length, width, and position of the vortex in the LV were recorded and quantitatively analyzed by BST echocardiography. The associations of vortex properties with ventricular function and morphology were also determined. RESULTS Based on BST imaging, the LV vortex can be observed in 93% of the fetuses. The fetuses with CoA exhibited significantly larger and wider vortex than the controls (P < .05). Linear regression analysis indicated that vortex area was positively related to sphericity index of LV as well as isovolumic relaxation time (r = .52, P = .003 and r = .42, P = .021). There was a negative correlation between vortex area and mitral valve size (r = -.443, P = .014). No significant association was found between vortex area and myocardial performance index and aortic isthmus size. CONCLUSIONS It is feasible to quantitatively evaluate the left ventricular vortex in fetuses by BST. The fetuses with CoA exhibited greater vortex area and width, and the altered vortex property is associated with geometry of LV. This will facilitate our comprehension of the unique flow patterns and early cardiac remodeling in fetuses with CoA.
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Affiliation(s)
- Dan Zhou
- Department of Ultrasound, Second Xiangya Hospital, Central South University, Changsha, China
| | - Ran Xu
- Department of Ultrasound, Second Xiangya Hospital, Central South University, Changsha, China
- Department of Urology, Second Xiangya Hospital, Central South University, Changsha, China
| | - Yushan Liu
- Department of Ultrasound, Second Xiangya Hospital, Central South University, Changsha, China
| | - Yang Yang
- Department of Ultrasound, Second Xiangya Hospital, Central South University, Changsha, China
| | - Zhongshi Wu
- Department of Cardiovascular Surgery, Second Xiangya Hospital, Central South University, Changsha, China
| | - Yuanchen Luo
- Department of Ultrasound, The First Hospital of Changsha, Changsha, China
| | - Shi Zeng
- Department of Ultrasound, Second Xiangya Hospital, Central South University, Changsha, China
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Maidu B, Martinez-Legazpi P, Guerrero-Hurtado M, Nguyen CM, Gonzalo A, Kahn AM, Bermejo J, Flores O, Del Alamo JC. Super-resolution Left Ventricular Flow and Pressure Mapping by Navier-Stokes-Informed Neural Networks. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2024:2024.04.12.589319. [PMID: 38659851 PMCID: PMC11042210 DOI: 10.1101/2024.04.12.589319] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/26/2024]
Abstract
Intraventricular vector flow mapping (VFM) is a growingly adopted echocardiographic modality that derives time-resolved two-dimensional flow maps in the left ventricle (LV) from color-Doppler sequences. Current VFM models rely on kinematic constraints arising from planar flow incompressibility. However, these models are not informed by crucial information about flow physics; most notably the pressure and shear forces within the fluid and the resulting accelerations. This limitation has rendered VFM unable to combine information from different time frames in an acquisition sequence or derive fluctuating pressure maps. In this study, we leveraged recent advances in artificial intelligence (AI) to develop AI-VFM, a vector flow mapping modality that uses physics-informed neural networks (PINNs) encoding mass conservation and momentum balance inside the LV, and no-slip boundary conditions at the LV endocardium. AI-VFM recovers the flow and pressure fields in the LV from standard echocardiographic scans. It performs phase unwrapping and recovers flow data in areas without input color-Doppler data. AI-VFM also recovers complete flow maps at time points without color-Doppler input data, producing super-resolution flow maps. We show that informing the PINNs with momentum balance is essential to achieving temporal super-resolution and significantly increases the accuracy of AI-VFM compared to informing the PINNs only with mass conservation. AI-VFM is solely informed by each patient's flow physics; it does not utilize explicit smoothness constraints or incorporate data from other patients or flow models. AI-VFM takes 15 minutes to run in off-the-shelf graphics processing units and its underlying PINN framework could be extended to map other flow-associated metrics like blood residence time or the concentration of coagulation species.
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Affiliation(s)
- Bahetihazi Maidu
- Dept. of Mechanical Engineering, University of Washington, Seattle, WA, USA
| | - Pablo Martinez-Legazpi
- Dept. of Mathematical Physics and Fluids. Universidad Nacional de Educación a Distancia & CIBERCV, Madrid, Spain
| | - Manuel Guerrero-Hurtado
- Dept. of Aerospace Engineering and Bioengineering, Universidad Carlos III De Madrid, Leganes, Spain
| | - Cathleen M Nguyen
- Dept. of Mechanical Engineering, University of Washington, Seattle, WA, USA
| | - Alejandro Gonzalo
- Dept. of Mechanical Engineering, University of Washington, Seattle, WA, USA
| | - Andrew M Kahn
- Division of Cardiovascular Medicine., University of California San Diego, La Jolla, CA, USA
| | - Javier Bermejo
- Dept. of Cardiology, Hospital General Universitario Gregorio Marañon & CIBERCV, Madrid, Spain
| | - Oscar Flores
- Dept. of Aerospace Engineering and Bioengineering, Universidad Carlos III De Madrid, Leganes, Spain
| | - Juan C Del Alamo
- Dept. of Mechanical Engineering, University of Washington, Seattle, WA, USA
- Center for Cardiovascular Biology, University of Washington School of Medicine, Seattle, WA, USA
- Division of Cardiology, University of Washington School of Medicine, Seattle, WA, USA
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Meyers BA, Zhang J, Nyce J, Loke YH, Vlachos PP. Enhanced echocardiographic assessment of intracardiac flow in congenital heart disease. PLoS One 2024; 19:e0300709. [PMID: 38498562 PMCID: PMC10947680 DOI: 10.1371/journal.pone.0300709] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Accepted: 03/04/2024] [Indexed: 03/20/2024] Open
Abstract
BACKGROUND 4D flow magnetic resonance imaging (4D flow MRI) can assess and measure the complex flow patterns of the right ventricle (RV) in congenital heart diseases, but its limited availability makes the broad application of intracardiac flow assessment challenging. Color Doppler imaging velocity reconstruction from conventional echocardiography is an emerging alternative, but its validity against 4D flow MRI needs to be established. OBJECTIVE To compare intracardiac flow parameters measured by color Doppler velocity reconstruction (DoVeR) against parameters measured from 4D flow MRI. METHODS We analyzed 20 subjects, including 7 normal RVs and 13 abnormal RVs (10 with repaired Tetralogy of Fallot, and 3 with atrial-level shunts). Intracardiac flow parameters such as relative pressure difference, vortex strength, total kinetic energy, and viscous energy loss were quantified using DoVeR and 4D flow MRI. The agreement between the two methods was determined by comparing the spatial fields and quantifying the cross-correlation and normalized difference between time-series measurements. RESULTS The hemodynamic parameters obtained from DoVeR and 4D flow MRI showed similar flow characteristics and spatial distributions. The time evolutions of the parameters were also in good agreement between the two methods. The median correlation coefficient between the time-series of any parameter was between 0.87 and 0.92, and the median L2-norm deviation was between 10% to 14%. CONCLUSIONS Our study shows that DoVeR is a reliable alternative to 4D flow MRI for quantifying intracardiac hemodynamic parameters in the RV.
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Affiliation(s)
- Brett A. Meyers
- School of Mechanical Engineering, Purdue University, West Lafayette, IN, United States of America
| | - Jiacheng Zhang
- School of Mechanical Engineering, Purdue University, West Lafayette, IN, United States of America
| | - Jonathan Nyce
- Division of Cardiology, Children’s National Hospital, Washington, DC, United States of America
| | - Yue-Hin Loke
- Division of Cardiology, Children’s National Hospital, Washington, DC, United States of America
| | - Pavlos P. Vlachos
- School of Mechanical Engineering, Purdue University, West Lafayette, IN, United States of America
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Cantinotti M, Marchese P, Franchi E, Santoro G, Assanta N, Giordano R. Four-Dimensional Flow Echocardiography: Blood Speckle Tracking in Congenital Heart Disease: How to Apply, How to Interpret, What Is Feasible, and What Is Missing Still. Healthcare (Basel) 2024; 12:263. [PMID: 38275542 PMCID: PMC10815034 DOI: 10.3390/healthcare12020263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Revised: 01/10/2024] [Accepted: 01/15/2024] [Indexed: 01/27/2024] Open
Abstract
Blood speckle tracking echocardiography (BSTE) is a new, promising 4D flow ultrafast non-focal plane imaging technique. The aim of the present investigation is to provide a review and update on potentialities and application of BSTE in children with congenital heart disease (CHD) and acquired heart disease. A literature search was performed within the National Library of Medicine using the keywords "echocardiography", "BST", and "children". The search was refined by adding the keywords "ultrafast imaging", "CHD", and "4D flow". Fifteen studies were finally included. Our analysis outlined how BSTE is highly feasible, fast, and easy for visualization of normal/abnormal flow patterns in healthy children and in those with CHD. BSTE allows for visualization and basic 2D measures of normal/abnormal vortices forming the ventricles and in the main vessel. Left ventricular vortex characteristics and aortic flow patterns have been described both in healthy children and in those with CHD. Complex analysis (e.g., energy loss, vorticity, and vector complexity) are also highly feasible with BSTE, but software is currently available only for research. Furthermore, current technology allows for BSTE only in neonates and low-weight children (e.g., <40 kg). In summary, the feasibility and potentialities of BSTE as a complementary diagnostic tool in children have been proved; however, its systemic use is hampered by the lack of (i) accessible tools for complex quantification and for acquisition at all ages/weight, (ii) data on the diagnostic/prognostic significance of BSTE, and (iii) consensus/recommendation papers indicating when and how BSTE should be employed.
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Affiliation(s)
- Massimiliano Cantinotti
- Fondazione G. Monasterio CNR-Regione Toscana, 54100 Massa, Italy; (M.C.); (P.M.); (E.F.); (G.S.); (N.A.)
| | - Pietro Marchese
- Fondazione G. Monasterio CNR-Regione Toscana, 54100 Massa, Italy; (M.C.); (P.M.); (E.F.); (G.S.); (N.A.)
- Istituto di Scienze Della Vita (ISV), Scuola Superiore Sant’Anna, 56127 Pisa, Italy
| | - Eliana Franchi
- Fondazione G. Monasterio CNR-Regione Toscana, 54100 Massa, Italy; (M.C.); (P.M.); (E.F.); (G.S.); (N.A.)
| | - Giuseppe Santoro
- Fondazione G. Monasterio CNR-Regione Toscana, 54100 Massa, Italy; (M.C.); (P.M.); (E.F.); (G.S.); (N.A.)
| | - Nadia Assanta
- Fondazione G. Monasterio CNR-Regione Toscana, 54100 Massa, Italy; (M.C.); (P.M.); (E.F.); (G.S.); (N.A.)
| | - Raffaele Giordano
- Adult and Pediatric Cardiac Surgery, Department of Advanced Biomedical Sciences, University of Naples “Federico II”, 80131 Naples, Italy
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Sachdeva R, Armstrong AK, Arnaout R, Grosse-Wortmann L, Han BK, Mertens L, Moore RA, Olivieri LJ, Parthiban A, Powell AJ. Novel Techniques in Imaging Congenital Heart Disease: JACC Scientific Statement. J Am Coll Cardiol 2024; 83:63-81. [PMID: 38171712 PMCID: PMC10947556 DOI: 10.1016/j.jacc.2023.10.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Revised: 10/05/2023] [Accepted: 10/13/2023] [Indexed: 01/05/2024]
Abstract
Recent years have witnessed exponential growth in cardiac imaging technologies, allowing better visualization of complex cardiac anatomy and improved assessment of physiology. These advances have become increasingly important as more complex surgical and catheter-based procedures are evolving to address the needs of a growing congenital heart disease population. This state-of-the-art review presents advances in echocardiography, cardiac magnetic resonance, cardiac computed tomography, invasive angiography, 3-dimensional modeling, and digital twin technology. The paper also highlights the integration of artificial intelligence with imaging technology. While some techniques are in their infancy and need further refinement, others have found their way into clinical workflow at well-resourced centers. Studies to evaluate the clinical value and cost-effectiveness of these techniques are needed. For techniques that enhance the value of care for congenital heart disease patients, resources will need to be allocated for education and training to promote widespread implementation.
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Affiliation(s)
- Ritu Sachdeva
- Department of Pediatrics, Division of Pediatric Cardiology, Emory University School of Medicine and Children's Healthcare of Atlanta, Atlanta, Georgia, USA.
| | - Aimee K Armstrong
- The Heart Center, Nationwide Children's Hospital, Department of Pediatrics, Division of Cardiology, Ohio State University, Columbus, Ohio, USA
| | - Rima Arnaout
- Division of Cardiology, Department of Medicine, University of California-San Francisco, San Francisco, California, USA
| | - Lars Grosse-Wortmann
- Division of Cardiology, Department of Pediatrics, Oregon Health and Science University, Portland, Oregon, USA
| | - B Kelly Han
- Division of Cardiology, Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Luc Mertens
- Division of Cardiology, Department of Pediatrics, University of Toronto and The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Ryan A Moore
- The Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Laura J Olivieri
- Division of Cardiology, Department of Pediatrics, Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Anitha Parthiban
- Department of Cardiology, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas, USA
| | - Andrew J Powell
- Department of Cardiology, Boston Children's Hospital, Boston, Massachusetts, USA; Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, USA
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Schäfer M, Mawad W. Advanced Imaging Technologies for Assessing Tetralogy of Fallot: Insights Into Flow Dynamics. CJC PEDIATRIC AND CONGENITAL HEART DISEASE 2023; 2:380-392. [PMID: 38161669 PMCID: PMC10755841 DOI: 10.1016/j.cjcpc.2023.09.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Accepted: 09/22/2023] [Indexed: 01/03/2024]
Abstract
Tetralogy of Fallot is the most common cyanotic congenital heart defect requiring surgical repair. Although surgical interventions have significantly reduced mortality, postrepair complications, such as pulmonary valve regurgitation and stenosis, may lead to adverse outcomes, including right ventricular dysfunction and increased risks of morbidity and mortality. This review explores the potential of advanced imaging technologies, including 4-dimensional-flow magnetic resonance imaging and high-frame-rate echocardiography, in providing valuable insights into blood flow dynamics and energy parameters. Quantitative measures, such as energy loss and vorticity, along with qualitative flow analysis, can provide additional insights into adverse haemodynamics at a potentially earlier and more reversible stage. Furthermore, personalized patient-specific information from these imaging modalities aids in guiding treatment decisions and monitoring postoperative interventions effectively. By characterizing flow patterns, these advanced imaging techniques hold great promise in improving the assessment and management of tetralogy of Fallot, providing tailored insights. However, further research and longitudinal studies are required to fully establish their clinical utility and potential impact on patient care.
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Affiliation(s)
- Michal Schäfer
- Division of Cardiothoracic Surgery, University of Utah, Salt Lake City, Utah, USA
| | - Wadi Mawad
- Montreal Children’s Hospital, McGill University Health Centre, Montreal, Québec, Canada
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Xu R, Hou M, Zhou D, Liu Y, Xie L, Zeng S. Visualizable intracardiac flow pattern in fetuses with congenital heart defect: pilot study of blood speckle-tracking echocardiography. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2023; 62:688-694. [PMID: 37161638 DOI: 10.1002/uog.26243] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Revised: 04/21/2023] [Accepted: 05/01/2023] [Indexed: 05/11/2023]
Abstract
OBJECTIVES Blood-flow pattern is an essential factor in cardiovascular development. Recently, blood speckle-tracking echocardiography (BST) based on high-frame-rate ultrasound has emerged as a promising technique for the assessment of blood-flow patterns and properties. The objectives of this study were to determine the feasibility of BST in the fetus and to assess intracardiac blood-flow patterns of fetuses with a congenital heart defect (CHD) using this technique. METHODS This was a prospective study consisting of 35 normal fetuses, 35 fetuses with left-sided obstructive lesion (LSOL) and 35 fetuses with right-sided obstructive lesion (RSOL). BST images of fetal intracardiac regions of interest (ROIs), including the left ventricle (LV), right ventricle (RV), ascending aorta (AAo), aortic arch (AA), descending aorta (DAo) and pulmonary artery (PA), were obtained and analyzed. The feasibility of BST was assessed, and blood-flow pattern and number of vortices in the ROIs were recorded. RESULTS The median gestational age of the fetuses was 24.7 weeks (range, 19.6-34.3 weeks). BST was feasible in 81.6% of cases, and the cut-off value of depth for an adequate BST image was ≤ 7.9 cm. There were no differences in the presence of vortex/turbulent blood flow in the LV or RV among the three groups. Vortex/turbulent blood flow in the AAo was detected in 0% (0/35), 14.3% (5/35) and 57.1% (20/35) of cases in the control, LSOL and RSOL groups, respectively. The respective values were 5.7% (2/35), 14.3% (5/35) and 51.4% (18/35) for the AA; 0% (0/35), 48.6% (17/35) and 0% (0/35) for the DAo; and 0% (0/35), 40.0% (14/35) and 51.4% (18/35) for the PA. With the exception of the DAo in the RSOL group, vortex/turbulent flow in the great artery ROIs was significantly more common in the LSOL and RSOL groups than in controls (P < 0.01). In the LSOL group, the number of vortices in the AAo, AA, DAo and PA was significantly greater compared with that in controls (P < 0.01). In the RSOL group, the number of vortices in the LV, AAo, AA and PA was significantly greater compared with that in controls (P < 0.01). CONCLUSIONS Fetuses with CHD were more likely to exhibit vortex/turbulent blood flow and increased number of vortices in the great arteries compared with healthy controls. Further research is needed to determine the biomechanical effect of blood-flow patterns, especially vortex flow, on fetal cardiovascular structure and function. © 2023 International Society of Ultrasound in Obstetrics and Gynecology.
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Affiliation(s)
- R Xu
- Department of Ultrasound, Second Xiangya Hospital, Central South University, Changsha, Hunan, China
- Department of Urology, Second Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - M Hou
- Department of Ultrasound, Second Xiangya Hospital, Central South University, Changsha, Hunan, China
- Department of Cardiovascular Surgery, Second Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - D Zhou
- Department of Ultrasound, Second Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Y Liu
- Department of Ultrasound, Second Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - L Xie
- Department of Cardiovascular Surgery, Second Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - S Zeng
- Department of Ultrasound, Second Xiangya Hospital, Central South University, Changsha, Hunan, China
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Henry M, Fadnes S, Lovstakken L, Mawad W, Mertens L, Nyrnes SA. Flow Dynamics in Children With Bicuspid Aortic Valve: A Blood Speckle Tracking Study. ULTRASOUND IN MEDICINE & BIOLOGY 2023; 49:2354-2360. [PMID: 37573177 DOI: 10.1016/j.ultrasmedbio.2023.07.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Revised: 06/27/2023] [Accepted: 07/16/2023] [Indexed: 08/14/2023]
Abstract
OBJECTIVE Bicuspid aortic valve (BAV) is associated with progressive aortic dilation. Although the etiology is complex, altered flow dynamics is thought to play an important role. Blood speckle tracking (BST) allows for visualization and quantification of complex flow, which could be useful in identifying patients at risk of root dilation and could aid in surgical planning. The aims of this study were to assess and quantify flow in the aortic root and left ventricle using BST in children with bicuspid aortic valves. METHODS AND RESULTS A total of 38 children <10 y of age were included (24 controls, 14 with BAV). Flow dynamics were examined using BST in the aortic root and left ventricle. Children with BAV had altered systolic flow patterns in the aortic root and higher aortic root average vorticity (25.9 [23.4-29.2] Hz vs. 17.8 [9.0-26.2] Hz, p < 0.05), vector complexity (0.17 [0.14-0.31] vs. 0.05 [0.02-0.13], p < 0.01) and rate of energy loss (7.9 [4.9-12.1] mW/m vs. 2.7 [1.2-7.4] mW/m, p = 0.01). Left ventricular average diastolic vorticity (20.9 ± 5.8 Hz vs. 11.4 ± 5.2 Hz, p < 0.01), kinetic energy (0.11 ± 0.05 J/m vs. 0.04 ± 0.02 J/m, p < 0.01), vector complexity (0.38 ± 0.1 vs. 0.23 ± 0.1, p < 0.01) and rate of energy loss (11.1 ± 4.8 mW/m vs. 2.7 ± 1.9 mW/m, p < 0.01) were higher in children with BAV. CONCLUSION Children with BAV exhibit altered flow dynamics in the aortic root and left ventricle in the absence of significant aortic root dilation. This may represent a substrate and potential predictor for future dilation and diastolic dysfunction.
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Affiliation(s)
| | - Solveig Fadnes
- Norwegian University of Science and Technology, Trondheim, Norway
| | - Lasse Lovstakken
- Norwegian University of Science and Technology, Trondheim, Norway
| | - Wadi Mawad
- McGill University Health Centre, Montreal, QC, Canada
| | - Luc Mertens
- Hospital for Sick Children, Toronto, ON, Canada
| | - Siri Ann Nyrnes
- Norwegian University of Science and Technology, Trondheim, Norway; Children's Clinic, St. Olav's University Hospital, Trondheim, Norway
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Sundström E, Jiang M, Najm HK, Tretter JT. Blood Speckle Imaging: An Emerging Method for Perioperative Evaluation of Subaortic and Aortic Valvar Repair. Bioengineering (Basel) 2023; 10:1183. [PMID: 37892913 PMCID: PMC10604765 DOI: 10.3390/bioengineering10101183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Revised: 10/03/2023] [Accepted: 10/06/2023] [Indexed: 10/29/2023] Open
Abstract
BACKGROUND This article presents the use of blood speckle Imaging (BSI) as an echocardiographic approach for the pre- and post-operative evaluation of subaortic membrane resection and aortic valve repair. METHOD BSI, employing block-matching algorithms, provided detailed visualization of flow patterns and quantification of parameters from ultrasound data. The 9-year-old patient underwent subaortic membrane resection and peeling extensions of the membrane from under the ventricular-facing surface of all three aortic valve leaflets. RESULT Post-operatively, BSI demonstrated improvements in hemodynamic patterns, where quantified changes in flow velocities showed no signs of stenosis and trivial regurgitation. The asymmetric jet with a shear layer and flow reversal on the posterior aspect of the aorta was corrected resulting in reduced wall shear stress on the anterior aspect and reduced oscillatory shear index, which is considered a contributing element in cellular alterations in the structure of the aortic wall. CONCLUSION This proof-of-concept study demonstrates the potential of BSI as an emerging echocardiographic approach for evaluating subaortic and aortic valvar repair. BSI enhances the quantitative evaluation of the left ventricular outflow tract of immediate surgical outcomes beyond traditional echocardiographic parameters and aids in post-operative decision-making. However, larger studies are needed to validate these findings and establish standardized protocols for clinical implementation.
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Affiliation(s)
- Elias Sundström
- Department of Engineering Mechanics, FLOW Research Center, KTH Royal Institute of Technology, Teknikringen 8, 100 44 Stockholm, Sweden
| | - Michael Jiang
- Department of Pediatric Cardiology, Cleveland Clinic, Cleveland, OH 44195, USA
| | - Hani K. Najm
- Congenital Valve Procedural Planning Center, Department of Pediatric Cardiology, Cleveland, OH 44195, USA
- Division of Pediatric Cardiac Surgery, and the Heart, Vascular, and Thoracic Institute, Cleveland Clinic, Cleveland, OH 44195, USA
| | - Justin T. Tretter
- Congenital Valve Procedural Planning Center, Department of Pediatric Cardiology, Cleveland, OH 44195, USA
- Division of Pediatric Cardiac Surgery, and the Heart, Vascular, and Thoracic Institute, Cleveland Clinic, Cleveland, OH 44195, USA
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Sujan MAJ, Skarstad HMS, Rosvold G, Fougner SL, Nyrnes SA, Iversen AC, Follestad T, Salvesen KÅ, Moholdt T. Randomised controlled trial of preconception lifestyle intervention on maternal and offspring health in people with increased risk of gestational diabetes: study protocol for the BEFORE THE BEGINNING trial. BMJ Open 2023; 13:e073572. [PMID: 37793933 PMCID: PMC10551988 DOI: 10.1136/bmjopen-2023-073572] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Accepted: 09/17/2023] [Indexed: 10/06/2023] Open
Abstract
INTRODUCTION Gestational diabetes mellitus (GDM) is associated with increased risk for type 2 diabetes in the mother and cardiometabolic diseases in the child. The preconception period is an optimal window to adapt the lifestyle for improved outcomes for both mother and child. Our aim is to determine the effect of a lifestyle intervention, initiated before and continued throughout pregnancy, on maternal glucose tolerance and other maternal and infant cardiometabolic outcomes. METHODS AND ANALYSIS This ongoing randomised controlled trial has included 167 females aged 18-39 years old at increased risk for GDM who are contemplating pregnancy. The participants were randomly allocated 1:1 to an intervention or control group. The intervention consists of exercise (volume is set by a heart rate-based app and corresponds to ≥ 1 hour of weekly exercise at ≥ 80% of individual heart rate maximum), and time-restricted eating (≤ 10 hours/day window of energy intake). The primary outcome measure is glucose tolerance in gestational week 28. Maternal and offspring outcomes are measured before and during pregnancy, at delivery, and at 6-8 weeks post partum. Primary and secondary continuous outcome measures will be compared between groups based on the 'intention to treat' principle using linear mixed models. ETHICS AND DISSEMINATION The Regional Committees for Medical and Health Research Ethics in Norway has approved the study (REK 143756). The anonymised results will be submitted for publication and posted in a publicly accessible database of clinical study results. TRIAL REGISTRATION NUMBER Clinical trial gov NCT04585581.
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Affiliation(s)
- Md Abu Jafar Sujan
- Department of Circulation and Medical Imaging, Norwegian University of Science and Technology, Trondheim, Norway
- Department of Women's Health, St Olavs Hospital Trondheim University Hospital, Trondheim, Norway
| | | | - Guro Rosvold
- Department of Circulation and Medical Imaging, Norwegian University of Science and Technology, Trondheim, Norway
| | - Stine Lyngvi Fougner
- Department of Endocrinology, St Olavs Hospital Trondheim University Hospital, Trondheim, Norway
- Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology, Trondheim, Norway
| | - Siri Ann Nyrnes
- Department of Circulation and Medical Imaging, Norwegian University of Science and Technology, Trondheim, Norway
- Children's Clinic, St Olavs Hospital Trondheim University Hospital, Trondheim, Norway
| | - Ann-Charlotte Iversen
- Department of Circulation and Medical Imaging, Norwegian University of Science and Technology, Trondheim, Norway
- Centre of Molecular Inflammation Research, Norwegian University of Science and Technology, Trondheim, Norway
| | - Turid Follestad
- Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology, Trondheim, Norway
- Clinical Research Unit Central Norway, St Olavs Hospital Trondheim University Hospital, Trondheim, Norway
| | - Kjell Å Salvesen
- Department of Women's Health, St Olavs Hospital Trondheim University Hospital, Trondheim, Norway
- Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology, Trondheim, Norway
| | - Trine Moholdt
- Department of Circulation and Medical Imaging, Norwegian University of Science and Technology, Trondheim, Norway
- Department of Women's Health, St Olavs Hospital Trondheim University Hospital, Trondheim, Norway
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11
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de Waal K, Phad N, Crendal E. Echocardiography algorithms to assess high left atrial pressure and grade diastolic function in preterm infants. Echocardiography 2023; 40:1099-1106. [PMID: 37658834 DOI: 10.1111/echo.15686] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Revised: 08/09/2023] [Accepted: 08/24/2023] [Indexed: 09/05/2023] Open
Abstract
BACKGROUND Relaxation, restoring forces, myocardial stiffness and atrial function determine left ventricular (LV) diastolic function. This study aims to provide a comprehensive assessment of diastolic function in preterm infants using conventional echocardiography and speckle tracking imaging and determine the diagnostic accuracy of various algorithms to detect high left atrial pressure (LAP). METHODS Preterm infants received an echocardiogram 1 week after birth and diastolic reference values were derived from the outer percentiles of stable preterm infants. Impaired relaxation, LV stiffness and high LAP were defined by using algorithms where at least half of the parameters were outside the normal range. Diastolic function was graded using the 2016 American Society of Echocardiography algorithm and expanded with the EA ratio and left atrial strain. The diagnostic accuracy of various algorithms to detect high LAP was determined with sensitivity analysis. RESULTS We studied 146 infants (59 stable) with a mean of 27(1) weeks gestation. Impaired relaxation, LV stiffness and high LAP were found in 8%, 7%, and 14% of infants. The patent ductus arteriosus was a contributing factor to high LAP and LV stiffness, not impaired relaxation. Diagnostic accuracy improved from 90% to 96% and sensitivity from 40% to 90% by adding left atrial strain to the 2016 algorithm. CONCLUSION Various grades of diastolic dysfunction could be appreciated in preterm infants using a multi-parameter approach. Adding left atrial strain improved sensitivity to detect infants with high LAP.
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Affiliation(s)
- Koert de Waal
- Department of Neonatology, John Hunter Children's Hospital Department of Neonatology and University of Newcastle, Newcastle NSW, Australia
| | - Nilkant Phad
- Department of Neonatology, John Hunter Children's Hospital Department of Neonatology and University of Newcastle, Newcastle NSW, Australia
| | - Edward Crendal
- Department of Neonatology, John Hunter Children's Hospital Department of Neonatology and University of Newcastle, Newcastle NSW, Australia
- Department of Cardiology, John Hunter Hospital Department of Cardiology, Newcastle NSW, Australia
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12
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Petrescu A, Voigt JU. [Echocardiography with high frame rates in the clinical practice : Principles, applications and perspectives]. Herz 2023; 48:339-351. [PMID: 37530782 DOI: 10.1007/s00059-023-05199-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/16/2023] [Indexed: 08/03/2023]
Abstract
Continuous developments in cardiovascular imaging, software and hardware have led to technological advancements that open new ways for assessing myocardial mechanics, hemodynamics, and function. Through new scan modalities, echocardiographic scanners can nowadays achieve very high frame rates up to 5000 frames s-1 which enables a wide variety of new applications, including shear wave elastography, ultrafast speckle tracking, the visualization of intracardiac blood flow and myocardial perfusion imaging. This review provides an overview of these advances and demonstrates possible applications and their potential added value in the clinical practice.
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Affiliation(s)
- Aniela Petrescu
- Abteilung für Kardiologie, Universitätsmedizin Mainz, Mainz, Deutschland
| | - Jens-Uwe Voigt
- Department of Cardiology, University Hospital Leuven, University of Leuven, Herestraat 49, 3000, Leuven, Belgien.
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13
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Mele D, Beccari R, Pedrizzetti G. Effect of Aging on Intraventricular Kinetic Energy and Energy Dissipation. J Cardiovasc Dev Dis 2023; 10:308. [PMID: 37504564 PMCID: PMC10380306 DOI: 10.3390/jcdd10070308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Revised: 07/10/2023] [Accepted: 07/17/2023] [Indexed: 07/29/2023] Open
Abstract
In recent years, analysis of kinetic energy (KE) and the rate of kinetic energy dissipation (KED) or energy loss (EL) within the cardiac chambers, obtained by cardiac imaging techniques, has gained increasing attention. Thus, there is a need to clarify the effect of physiological variables, specifically aging, on these energetic measures. To elucidate this aspect, we reviewed the literature on this topic. Overall, cardiac magnetic resonance and echocardiographic studies published so far indicate that aging affects the energetics of left and right intraventricular blood flow, although not all energy measures during the cardiac cycle seem to be affected by age in the same way. Current studies, however, have limitations. Additional large, multicenter investigations are needed to test the effect of physiological variables on intraventricular KE and KED/EL measures.
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Affiliation(s)
- Donato Mele
- Department of Cardiac Thoracic Vascular Sciences and Public Health, University of Padova, 35128 Padova, Italy
| | - Riccardo Beccari
- Department of Cardiac Thoracic Vascular Sciences and Public Health, University of Padova, 35128 Padova, Italy
| | - Gianni Pedrizzetti
- Department of Engineering and Architecture, University of Trieste, 34127 Trieste, Italy
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14
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Zheng AS, Yu HX. Value of clinical applications of differential pressure and relative pressure imaging in the left ventricle. World J Clin Cases 2023; 11:3967-3975. [PMID: 37388805 PMCID: PMC10303603 DOI: 10.12998/wjcc.v11.i17.3967] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2023] [Revised: 04/15/2023] [Accepted: 05/06/2023] [Indexed: 06/12/2023] Open
Abstract
Regional pressure differences between sites within the left ventricular cavity have long been identified, and the potential clinical value of diastolic and systolic intraventricular pressure differences (IVPDs) is of increasing interest. This study concluded that the IVPD plays an important role in ventricular filling and emptying and is a reliable indicator of ventricular relaxation, elastic recoil, diastolic pumping, and effective left ventricular filling. Relative pressure imaging, as a novel and potentially clinically applicable measure of left IVPDs, enables early and more comprehensive identification of the temporal and spatial characteristics of IVPD. In the future, as research related to relative pressure imaging continues, this measurement method has the possibility to become more refined and serve as an additional clinical aid that can replace the gold standard cardiac catheterization technique for the diagnosis of diastolic dysfunction.
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Affiliation(s)
- An-Sheng Zheng
- Department of Ultrasound Medicine, The Second Affiliated Hospital of Zhengzhou University, Zhengzhou 450002, Henan Province, China
| | - Hong-Xia Yu
- Department of Ultrasound Medicine, The Second Affiliated Hospital of Zhengzhou University, Zhengzhou 450002, Henan Province, China
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15
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Meyers B, Nyce J, Zhang J, Frank LH, Balaras E, Vlachos PP, Loke YH. Intracardiac Flow Analysis of the Right Ventricle in Pediatric Patients With Repaired Tetralogy of Fallot Using a Novel Color Doppler Velocity Reconstruction. J Am Soc Echocardiogr 2023; 36:644-653. [PMID: 36822439 PMCID: PMC10247486 DOI: 10.1016/j.echo.2023.02.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Revised: 02/08/2023] [Accepted: 02/10/2023] [Indexed: 02/25/2023]
Abstract
BACKGROUND Repaired tetralogy of Fallot (RTOF) patients will develop right ventricular (RV) dysfunction from chronic pulmonary regurgitation (PR). Cardiac magnetic resonance sequences such as four-dimensional flow can demonstrate altered vorticity and flow energy loss (FEL); however, they are not as available as conventional echocardiography (echo). The study determined whether a novel, vendor-independent Doppler velocity reconstruction (DoVeR) could measure RV intracardiac flow in conventional echo of RTOF patients. The primary hypothesis was that DoVeR could detect increased vorticity and diastolic FEL in RTOF patients. METHODS Repaired tetralogy of Fallot patients with echo were retrospectively paired with age-/size-matched controls. Doppler velocity reconstruction employed the stream function-vorticity equation to approximate intracardiac flow fields from color Doppler. A velocity field of the right ventricle was reconstructed from the apical 4-chamber view. Vortex strength (VS, area integral of vorticity) and FEL were derived from DoVeR. Cardiac magnetic resonance and exercise stress parameters (performed within 1 year of echo) were collected for analysis. RESULTS Twenty RTOF patients and age-matched controls were included in the study. Mean regurgitant fraction was 40.5% ± 7.6%, and indexed RV end-diastolic volume was 158 ± 36 mL/m2. Repaired tetralogy of Fallot patients had higher total, mean diastolic, and peak diastolic VS (P = .0013, P = .0012, P = .0032, respectively) and higher total, mean diastolic, and peak diastolic body surface area-indexed FEL (P = .0016, P = .0022, P < .001, respectively). Peak diastolic indexed FEL and peak diastolic VS had weak-to-moderate negative correlation with RV ejection fraction (r = -0.52 [P = .019] and r = -0.49 [P = .030], respectively) and left ventricular ejection fraction (r = -0.47 [P = .034] and r = -0.64 [P = .002], respectively). Mean diastolic indexed FEL and VS had moderate-to-strong negative correlation with percent predicted maximal oxygen consumption (r = -0.69 [P = .012] and r = -0.75 [P = .006], respectively). CONCLUSIONS DoVeR can detect alterations to intracardiac flow in RTOF patients from conventional color Doppler imaging. Echo-based measures of diastolic VS and FEL correlated with ventricular function. DoVeR has the potential to provide serial evaluation of abnormal flow dynamics in RTOF patients.
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Affiliation(s)
- Brett Meyers
- School of Mechanical Engineering, Purdue University, West Lafayette, Indiana
| | - Jonathan Nyce
- Department of Cardiology, Children's National Hospital, Washington, D.C
| | - Jiacheng Zhang
- School of Mechanical Engineering, Purdue University, West Lafayette, Indiana
| | - Lowell H Frank
- Department of Cardiology, Children's National Hospital, Washington, D.C
| | - Elias Balaras
- School of Engineering & Applied Science, George Washington University, Washington, D.C
| | - Pavlos P Vlachos
- School of Mechanical Engineering, Purdue University, West Lafayette, Indiana
| | - Yue-Hin Loke
- Department of Cardiology, Children's National Hospital, Washington, D.C..
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16
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Cantinotti M, Marchese P, Scalese M, Giordano R, Franchi E, Assanta N, Koestenberger M, Barnes BT, Celi S, Jani V, Voges I, Kutty S. Characterization of Aortic Flow Patterns by High-Frame-Rate Blood Speckle Tracking Echocardiography in Children. J Am Heart Assoc 2023; 12:e026335. [PMID: 37066781 PMCID: PMC10227241 DOI: 10.1161/jaha.122.026335] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Accepted: 12/26/2022] [Indexed: 04/18/2023]
Abstract
Background Blood speckle tracking echocardiography allows for direct quantification of interventricular and aortic flow profiles, principally in children. Here, we sought to demonstrate the feasibility and reproducibility of blood speckle tracking echocardiography in the aortas of healthy children. Methods and Results One hundred healthy White children evaluated for the screening of congenital heart disease were prospectively enrolled. Echocardiographic examinations were performed using a Vivid E 95 ultrasound system, with blood speckle tracking from a focused and zoomed view of the aortic root and the ascending aorta. Vortex position, height (mm), width (mm), sphericity index, and area (cm2) were measured and indexed by body surface area. Median (interquartile range) age was 8.2 (5.6-11.0) years, median (interquartile range) weight was 28 (19-35) kg, and median (interquartile range) body surface area was 1.01 (0.79-1.16) m2. Vortices were visualized in only a single phase of the cardiac cycle in 25 subjects-14 (56.0%) were evident in early diastole and 11 (44.0%) in late systole. Vortices visualized in diastole had a mean area of 0.27±0.1 cm2/m2, while those in systole had a mean area of 0.34±0.12 cm2/m2. In a subset of 20 patients, inter- and intraobserver coefficient of variation and intraclass correlation coefficients were determined and showed good reproducibility. Conclusions We demonstrate feasibility and reproducibility of blood speckle tracking and identified vortical flow patterns in the aortic root and ascending aorta in healthy children. These data may serve as a baseline for evaluating aortic flow patterns in children with congenital and acquired heart disease.
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Affiliation(s)
- Massimiliano Cantinotti
- Fondazione G. Monasterio CNR‐Regione ToscanaMassa, PisaItaly
- Adult Institute of Clinical PhysiologyPisaItaly
| | - Pietro Marchese
- Fondazione G. Monasterio CNR‐Regione ToscanaMassa, PisaItaly
- Scuola Superiore Sant’AnnaPisaItaly
| | | | - Raffaele Giordano
- Adult and Pediatric Cardiac Surgery, Department Advanced Biomedical SciencesUniversity of Naples “Federico II”NapoliItaly
| | - Eliana Franchi
- Fondazione G. Monasterio CNR‐Regione ToscanaMassa, PisaItaly
| | - Nadia Assanta
- Fondazione G. Monasterio CNR‐Regione ToscanaMassa, PisaItaly
| | - Martin Koestenberger
- Division of Pediatric Cardiology, Department of PediatricsMedical University GrazGrazAustria
| | - Benjamin T. Barnes
- Department of PediatricsTaussig Heart Center, Johns Hopkins HospitalBaltimoreMDUSA
| | - Simona Celi
- Fondazione G. Monasterio CNR‐Regione ToscanaMassa, PisaItaly
| | - Vivek Jani
- Department of PediatricsTaussig Heart Center, Johns Hopkins HospitalBaltimoreMDUSA
| | - Inga Voges
- Department for Congenital Cardiology and Pediatric CardiologyUniversity Hospital Schleswig‐HolsteinCampus KielGermany
| | - Shelby Kutty
- Department of PediatricsTaussig Heart Center, Johns Hopkins HospitalBaltimoreMDUSA
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17
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Salih AK, ALWAN AH, Opulencia MJC, Uinarni H, Khamidova FM, Atiyah MS, Awadh SA, Hammid AT, Arzehgar Z. Evaluation of Cholesterol Thickness of Blood Vessels Using Photoacoustic Technology. BIOMED RESEARCH INTERNATIONAL 2023; 2023:2721427. [PMID: 37090193 PMCID: PMC10115531 DOI: 10.1155/2023/2721427] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/17/2022] [Revised: 06/05/2022] [Accepted: 06/24/2022] [Indexed: 04/25/2023]
Abstract
One of the primary indicators of plaque vulnerability is the lipid composition of atherosclerotic plaques. Therefore, the medical industry requires a method to evaluate necrotic nuclei in atherosclerosis imaging with sensitivity. In this regard, photoacoustic imaging is a plaque detection method that provides chemical information on lipids and cholesterol thickness in the arterial walls of the patient. This aspect aims to increase the low-frequency axial resolution by developing a new photoacoustic-based system. A photoacoustic system has been developed to detect the cholesterol thickness of the blood vessels to observe the progression of plaque in the heart's blood vessels. The application of the coherent photoacoustic discontinuous correlation tomography technique, which is based on a novel signal processing, significantly increased the cholesterol oleate's sensitivity to plaque necrosis. By enhancing the quality of thickness detection, the system for measuring the thickness of cholesterol in blood vessels has been reduced to approximately 23 microns. The results show that the phase spectrum peaked at 100 Hz at 58.66 degrees, and at 400 Hz, the phase spectrum was 46.37 degrees. The minimum amplitude is 1.95 at 100 Hz and 17.67 at 400 Hz. In conclusion, it can be stated that photoacoustic imaging as a method based on new technologies is of great importance in medical research, which is based on the use of nonionizing radiation to perform diagnostic processes and measure different types of body tissues.
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Affiliation(s)
| | - Ala Hadi ALWAN
- Ibn Al-Bitar Specialized Center for Cardiac Surgery, Baghdad, Iraq
| | | | - Herlina Uinarni
- Atma Jaya Catholic University of Indonesia, Jakarta, Indonesia
- Pantai Indah Kapuk Hospital, North Jakarta, Indonesia
| | - Firuza M. Khamidova
- Department of Ophthalmology, Samarkand State Medical Institute, Samarkand, Uzbekistan
- Tashkent State Dental Institute, Tashkent, Uzbekistan
| | | | | | | | - Zeinab Arzehgar
- Department of Chemistry, Payame Noor University, Tehran, Iran
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18
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Zheng Q, Qiao W, Ren W, Xiao Y. Isolated muscular ventricular diverticulum assessment using multi-parameter echocardiographic imaging: Case reports. Echocardiography 2023; 40:289-294. [PMID: 36740936 DOI: 10.1111/echo.15536] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Revised: 12/09/2022] [Accepted: 01/20/2023] [Indexed: 02/07/2023] Open
Abstract
Ventricular diverticulum (VDi) is a rare and often asymptomatic congenital cardiac malformation detected incidentally as an outpouching on routine imaging examination, of which the muscular type has been less reported. Here, two patients were incidentally found to have outpouchings of the ventricle during routine transthoracic echocardiography. After a series of multi-parameter echocardiography examination, including two-dimensional (2D), three-dimensional (3D) photo-realistic rendering, blood speckle tracking (BST), and contrast enhancement, to provide morphological structure, spatial relationship, and blood flow information, both cases were finally diagnosed with muscular VDi. These cases highlight the advantages of using multi-parameter echocardiography for the comprehensive assessment of muscular VDi.
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Affiliation(s)
- Qiaojin Zheng
- Department of Ultrasound, Shengjing Hospital of China Medical University, Shenyang, China
| | - Wei Qiao
- Department of Ultrasound, Shengjing Hospital of China Medical University, Shenyang, China
| | - Weidong Ren
- Department of Ultrasound, Shengjing Hospital of China Medical University, Shenyang, China
| | - Yangjie Xiao
- Department of Ultrasound, Shengjing Hospital of China Medical University, Shenyang, China
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19
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Sørensen K, Fadnes S, Mertens L, Henry M, Segers P, Løvstakken L, Nyrnes SA. Assessment of Early Diastolic Intraventricular Pressure Difference in Children by Blood Speckle-Tracking Echocardiography. J Am Soc Echocardiogr 2023; 36:523-532.e3. [PMID: 36632939 DOI: 10.1016/j.echo.2022.12.025] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Revised: 12/24/2022] [Accepted: 12/30/2022] [Indexed: 01/10/2023]
Abstract
BACKGROUND The lack of reliable echocardiographic techniques to assess diastolic function in children is a major clinical limitation. Our aim was to develop and validate the intraventricular pressure difference (IVPD) calculation using blood speckle-tracking (BST) and investigate the method's potential role in the assessment of diastolic function in children. METHODS Blood speckle-tracking allows two-dimensional angle-independent blood flow velocity estimation. Blood speckle-tracking images of left ventricular (LV) inflow from the apical 4-chamber view in 138 controls, 10 patients with dilated cardiomyopathies (DCMs), and 21 patients with hypertrophic cardiomyopathies (HCMs) <18 years of age were analyzed to study LV IVPD during early diastole. Reproducibility of the IVPD analysis was assessed, IVPD estimates from BST and color M mode were compared, and the validity of the BST-based IVPD calculations was tested in a computer flow model. RESULTS Mean IVPD was significantly higher in controls (-2.28 ± 0.62 mm Hg) compared with in DCM (-1.21 ± 0.39 mm Hg, P < .001) and HCM (-1.57 ± 0.47 mm Hg, P < .001) patients. Feasibility was 88.3% in controls, 80% in DCM patients, and 90.4% in HCM patients. The peak relative negative pressure occurred earlier at the apex than at the base and preceded the peak E-wave LV filling velocity, indicating that it represents diastolic suction. Intraclass correlation coefficients for intra- and interobserver variability were 0.908 and 0.702, respectively. There was a nonsignificant mean difference of 0.15 mm Hg between IVPD from BST and color M mode. Estimation from two-dimensional velocities revealed a difference in peak IVPD of 0.12 mm Hg (6.6%) when simulated in a three-dimensional fluid mechanics model. CONCLUSIONS Intraventricular pressure difference calculation from BST is highly feasible and provides information on diastolic suction and early filling in children with heart disease. Intraventricular pressure difference was significantly reduced in children with DCM and HCM compared with controls, indicating reduced early diastolic suction in these patient groups.
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Affiliation(s)
- Kristian Sørensen
- Department of Circulation and Medical Imaging, Norwegian University of Science and Technology, Trondheim, Norway; Division of Ålesund Hospital, Department of Pediatrics, Møre and Romsdal Hospital Trust, Ålesund, Norway.
| | - Solveig Fadnes
- Department of Circulation and Medical Imaging, Norwegian University of Science and Technology, Trondheim, Norway; Division of Ålesund Hospital, Department of Pediatrics, Møre and Romsdal Hospital Trust, Ålesund, Norway
| | - Luc Mertens
- Department of Cardiology, the Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Matthew Henry
- Department of Cardiology, the Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Patrick Segers
- Department of Electronics and Information Systems, IBiTech-bioMMeda, Ghent University, Ghent, Belgium
| | - Lasse Løvstakken
- Department of Circulation and Medical Imaging, Norwegian University of Science and Technology, Trondheim, Norway
| | - Siri Ann Nyrnes
- Department of Circulation and Medical Imaging, Norwegian University of Science and Technology, Trondheim, Norway; Children's Clinic, St. Olav`s Hospital, Trondheim University Hospital, Trondheim, Norway
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Hasegawa H, Omura M, Nagaoka R, Saito K. Two-Dimensional Wavenumber Analysis Implemented in Ultrasonic Vector Doppler Method with Focused Transmit Beams. SENSORS (BASEL, SWITZERLAND) 2022; 22:9787. [PMID: 36560161 PMCID: PMC9781179 DOI: 10.3390/s22249787] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Revised: 12/05/2022] [Accepted: 12/09/2022] [Indexed: 06/17/2023]
Abstract
The multi-angle Doppler method was introduced for the estimation of velocity vectors by measuring axial velocities from multiple directions. We have recently reported that the autocorrelation-based velocity vector estimation could be ameliorated significantly by estimating the wavenumbers in two dimensions. Since two-dimensional wavenumber estimation requires a snapshot of an ultrasonic field, the method was first implemented in plane wave imaging. Although plane wave imaging is predominantly useful for examining blood flows at an extremely high temporal resolution, it was reported that the contrast in a B-mode image obtained with a few plane wave emissions was lower than that obtained with focused beams. In this study, the two-dimensional wavenumber analysis was first implemented in a framework with focused transmit beams. The simulations showed that the proposed method achieved an accuracy in velocity estimation comparable to that of the method with plane wave imaging. Furthermore, the performances of the methods implemented in focused beam and plane wave imaging were compared by measuring human common carotid arteries in vivo. Image contrasts were analyzed in normal and clutter-filtered B-mode images. The method with focused beam imaging achieved a better contrast in normal B-mode imaging, and similar velocity magnitudes and angles were obtained by both the methods with focused beam and plane wave imaging. In contrast, the method with plane wave imaging gave a better contrast in a clutter-filtered B-mode image and smaller variances in velocity magnitudes than those with focused beams.
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Affiliation(s)
- Hideyuki Hasegawa
- Faculty of Engineering, University of Toyama, Toyama 930-8555, Japan
| | - Masaaki Omura
- Faculty of Engineering, University of Toyama, Toyama 930-8555, Japan
| | - Ryo Nagaoka
- Faculty of Engineering, University of Toyama, Toyama 930-8555, Japan
| | - Kozue Saito
- Department of Neurology, Stroke Center, Nara Medical University, Nara 634-8522, Japan
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21
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Mawad W, Fadnes S, Løvstakken L, Henry M, Mertens L, Nyrnes SA. Pulmonary Hypertension in Children is Associated With Abnormal Flow Patterns in the Main Pulmonary Artery as Demonstrated by Blood Speckle Tracking. CJC PEDIATRIC AND CONGENITAL HEART DISEASE 2022; 1:213-218. [PMID: 37969432 PMCID: PMC10642129 DOI: 10.1016/j.cjcpc.2022.09.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/03/2022] [Accepted: 09/01/2022] [Indexed: 11/17/2023]
Abstract
Background Paediatric pulmonary arterial hypertension (PAH) is characterized by increased pulmonary vascular resistance resulting in increased pulmonary artery (PA) and right ventricular pressure (RV). This is associated with disturbed flow dynamics in the PA and RV that are not well characterized. We aimed to compare flow dynamics in children with PAH compared with healthy controls using blood speckle tracking echocardiography. Methods Patients <10 years of age with PAH and healthy controls were included. We examined flow dynamics in the main PA (MPA) and right ventricle based on acquisition blood speckle tracking images obtained from the RV and PA. Qualitative and quantitative analyses were performed. Results Eighteen subjects were included in each group. A diastolic vortex in the MPA was identified in 16 of the patients with PAH, but not in controls. Significantly higher MPA systolic (4.84 vs 2.42 mW/m; P = 0.01) and diastolic (0.69 vs 0.14 mW/m; P = 0.01) energy loss, as well as increased vector complexity (systole: 0.21 vs 0.04, P = 0.003; diastole: 0.13 vs 0.05, P = 0.04) and diastolic vorticity (15.2 vs 4.4 Hz; P = 0.001), were noted in PAH compared with controls. Conclusion This study demonstrates the presence of abnormal flow patterns in the MPA with diastolic vortex formation in most patients with PAH. This diastolic vortex likely results from reflected waves from the distal pulmonary bed. Our data indicate that the diastolic vortex could potentially be used in the diagnosis of PAH. The clinical significance of the energy loss findings warrants further investigation in a larger cohort of patients with PAH.
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Affiliation(s)
- Wadi Mawad
- Division of Cardiology, Department of Paediatric, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
- Department of Circulation and Medical Imaging, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
- Department of Paediatrics, Montreal Children’s Hospital, McGill University Health Centre, Montréal, Québec, Canada
| | - Solveig Fadnes
- Department of Circulation and Medical Imaging, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
- Moere & Romsdal Hospital Trust, Division of Aalesund Hospital, Department of Pediatrics, Aalesund, Norway
| | - Lasse Løvstakken
- Department of Circulation and Medical Imaging, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - Matthew Henry
- Division of Cardiology, Department of Paediatric, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Luc Mertens
- Division of Cardiology, Department of Paediatric, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Siri Ann Nyrnes
- Department of Circulation and Medical Imaging, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
- Children’s Clinic, St. Olavs University Hospital, Trondheim, Norway
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Postigo A, Viola F, Chazo C, Martínez-Legazpi P, González-Mansilla A, Rodríguez-González E, Fernández-Avilés F, Del Álamo JC, Ebbers T, Bermejo J. Assessment of Blood Flow Transport in the Left Ventricle Using Ultrasound. Validation Against 4-D Flow Cardiac Magnetic Resonance. ULTRASOUND IN MEDICINE & BIOLOGY 2022; 48:1822-1832. [PMID: 35764455 PMCID: PMC10408642 DOI: 10.1016/j.ultrasmedbio.2022.05.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Revised: 05/04/2022] [Accepted: 05/08/2022] [Indexed: 06/15/2023]
Abstract
Four-dimensional flow cardiac magnetic resonance (CMR) is the reference technique for analyzing blood transport in the left ventricle (LV), but similar information can be obtained from ultrasound. We aimed to validate ultrasound-derived transport in a head-to-head comparison against 4D flow CMR. In five patients and two healthy volunteers, we obtained 2D + t and 3D + t (4D) flow fields in the LV using transthoracic echocardiography and CMR, respectively. We compartmentalized intraventricular blood flow into four fractions of end-diastolic volume: direct flow (DF), retained inflow (RI), delayed ejection flow (DEF) and residual volume (RV). Using ultrasound we also computed the properties of LV filling waves (percentage of LV penetration and percentage of LV volume carried by E/A waves) to determine their relationships with CMR transport. Agreement between both techniques for quantifying transport fractions was good for DF and RV (Ric [95% confidence interval]: 0.82 [0.33, 0.97] and 0.85 [0.41, 0.97], respectively) and moderate for RI and DEF (Ric= 0.47 [-0.29, 0.88] and 0.55 [-0.20, 0.90], respectively). Agreement between techniques to measure kinetic energy was variable. The amount of blood carried by the E-wave correlated with DF and RV (R = 0.75 and R = 0.63, respectively). Therefore, ultrasound is a suitable method for expanding the analysis of intraventricular flow transport in the clinical setting.
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Affiliation(s)
- Andrea Postigo
- Department of Cardiology, Hospital General Universitario Gregorio Marañón, Facultad de Medicina, Universidad Complutense de Madrid, Instituto de Investigación Sanitaria Gregorio Marañón, CIBERCV, Madrid, Spain
| | - Federica Viola
- Department of Health, Medicine and Caring Sciences and Center for Medical Image Science and Visualization, Linköping University, Linköping, Sweden
| | - Christian Chazo
- Department of Cardiology, Hospital General Universitario Gregorio Marañón, Facultad de Medicina, Universidad Complutense de Madrid, Instituto de Investigación Sanitaria Gregorio Marañón, CIBERCV, Madrid, Spain
| | - Pablo Martínez-Legazpi
- Department of Mathematical Physics and Fluids, Facultad de Ciencias, Universidad Nacional de Educación a Distancia, UNED and CIBERCV, Madrid, Spain
| | - Ana González-Mansilla
- Department of Cardiology, Hospital General Universitario Gregorio Marañón, Facultad de Medicina, Universidad Complutense de Madrid, Instituto de Investigación Sanitaria Gregorio Marañón, CIBERCV, Madrid, Spain
| | - Elena Rodríguez-González
- Department of Cardiology, Hospital General Universitario Gregorio Marañón, Facultad de Medicina, Universidad Complutense de Madrid, Instituto de Investigación Sanitaria Gregorio Marañón, CIBERCV, Madrid, Spain
| | - Francisco Fernández-Avilés
- Department of Cardiology, Hospital General Universitario Gregorio Marañón, Facultad de Medicina, Universidad Complutense de Madrid, Instituto de Investigación Sanitaria Gregorio Marañón, CIBERCV, Madrid, Spain
| | - Juan C Del Álamo
- Mechanical Engineering Department, Center for Cardiovascular Biology, Institute for Stem Cell and Regenerative Medicine, University of Washington, Seattle, Washington, USA
| | - Tino Ebbers
- Department of Health, Medicine and Caring Sciences and Center for Medical Image Science and Visualization, Linköping University, Linköping, Sweden
| | - Javier Bermejo
- Department of Cardiology, Hospital General Universitario Gregorio Marañón, Facultad de Medicina, Universidad Complutense de Madrid, Instituto de Investigación Sanitaria Gregorio Marañón, CIBERCV, Madrid, Spain.
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23
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Blood speckle imaging compared with conventional Doppler ultrasound for transvalvular pressure drop estimation in an aortic flow phantom. Cardiovasc Ultrasound 2022; 20:18. [PMID: 35840940 PMCID: PMC9287947 DOI: 10.1186/s12947-022-00286-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Accepted: 06/27/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Transvalvular pressure drops are assessed using Doppler echocardiography for the diagnosis of heart valve disease. However, this method is highly user-dependent and may overestimate transvalvular pressure drops by up to 54%. This work aimed to assess transvalvular pressure drops using velocity fields derived from blood speckle imaging (BSI), as a potential alternative to Doppler. METHODS: A silicone 3D-printed aortic valve model, segmented from a healthy CT scan, was placed within a silicone tube. A CardioFlow 5000MR flow pump was used to circulate blood mimicking fluid to create eight different stenotic conditions. Eight PendoTech pressure sensors were embedded along the tube wall to record ground-truth pressures (10 kHz). The simplified Bernoulli equation with measured probe angle correction was used to estimate pressure drop from maximum velocity values acquired across the valve using Doppler and BSI with a GE Vivid E95 ultrasound machine and 6S-D cardiac phased array transducer. RESULTS There were no significant differences between pressure drops estimated by Doppler, BSI and ground-truth at the lowest stenotic condition (10.4 ± 1.76, 10.3 ± 1.63 vs. 10.5 ± 1.00 mmHg, respectively; p > 0.05). Significant differences were observed between the pressure drops estimated by the three methods at the greatest stenotic condition (26.4 ± 1.52, 14.5 ± 2.14 vs. 20.9 ± 1.92 mmHg for Doppler, BSI and ground-truth, respectively; p < 0.05). Across all conditions, Doppler overestimated pressure drop (Bias = 3.92 mmHg), while BSI underestimated pressure drop (Bias = -3.31 mmHg). CONCLUSIONS BSI accurately estimated pressure drops only up to 10.5 mmHg in controlled phantom conditions of low stenotic burden. Doppler overestimated pressure drops of 20.9 mmHg. Although BSI offers a number of theoretical advantages to conventional Doppler echocardiography, further refinements and clinical studies are required with BSI before it can be used to improve transvalvular pressure drop estimation in the clinical evaluation of aortic stenosis.
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24
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Jain A, Wessler BS. Mitral Regurgitation-When One View Isn't Enough. J Cardiothorac Vasc Anesth 2022; 36:2237-2239. [PMID: 35370075 DOI: 10.1053/j.jvca.2022.02.035] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Accepted: 02/23/2022] [Indexed: 11/11/2022]
Affiliation(s)
- Ankit Jain
- Department of Anesthesiology and Perioperative Medicine, Medical College of Georgia at Augusta University Augusta, GA.
| | - Benjamin S Wessler
- Division of Cardiology, Assistant Professor of Medicine , Tufts University School of Medicine, Boston, MA
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25
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Comparison of ultrasound vector flow imaging and CFD simulations with PIV measurements of flow in a left ventricular outflow trackt phantom - Implications for clinical use and in silico studies. Comput Biol Med 2022; 146:105358. [DOI: 10.1016/j.compbiomed.2022.105358] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Revised: 02/10/2022] [Accepted: 02/25/2022] [Indexed: 11/21/2022]
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26
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van Amerom JFP, Goolaub DS, Schrauben EM, Sun L, Macgowan CK, Seed M. Fetal cardiovascular blood flow MRI: techniques and applications. Br J Radiol 2022:20211096. [DOI: 10.1259/bjr.20211096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Fetal cardiac MRI is challenging due to fetal and maternal movements as well as the need for a reliable cardiac gating signal and high spatiotemporal resolution. Ongoing research and recent technical developments to address these challenges show the potential of MRI as an adjunct to ultrasound for the assessment of the fetal heart and great vessels. MRI measurements of blood flow have enabled the assessment of normal fetal circulation as well as conditions with disrupted circulations, such as congenital heart disease, along with associated organ underdevelopment and hemodynamic instability. This review provides details of the techniques used in fetal cardiovascular blood flow MRI, including single slice and volumetric imaging sequences, post-processing and analysis, along with a summary of applications in human studies and animal models.
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Affiliation(s)
- Joshua FP van Amerom
- Division of Translational Medicine, SickKids Research Institute, Toronto, Canada
| | - Datta Singh Goolaub
- Division of Translational Medicine, SickKids Research Institute, Toronto, Canada
- Department of Medical Biophysics, University of Toronto, Toronto, Canada
| | - Eric M Schrauben
- Department of Radiology & Nuclear Medicine, Amsterdam University Medical Centers, Amsterdam, Netherlands
| | - Liqun Sun
- Division of Cardiology, Hospital for Sick Children, Toronto, Canada
- Department of Paediatrics, University of Toronto, Toronto, Canada
| | - Christopher K Macgowan
- Division of Translational Medicine, SickKids Research Institute, Toronto, Canada
- Department of Medical Biophysics, University of Toronto, Toronto, Canada
| | - Mike Seed
- Division of Translational Medicine, SickKids Research Institute, Toronto, Canada
- Division of Cardiology, Hospital for Sick Children, Toronto, Canada
- Department of Paediatrics, University of Toronto, Toronto, Canada
- Department of Diagnostic Imaging, Hospital for Sick Children, Toronto, Canada
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27
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Vixège F, Berod A, Courand PY, Mendez S, Nicoud F, Blanc-Benon P, Vray D, Garcia D. Full-volume three-component intraventricular vector flow mapping by triplane color Doppler. Phys Med Biol 2022; 67. [DOI: 10.1088/1361-6560/ac62fe] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Accepted: 03/31/2022] [Indexed: 11/11/2022]
Abstract
Abstract
Objective. Intraventricular vector flow mapping (iVFM) is a velocimetric technique for retrieving two-dimensional velocity vector fields of blood flow in the left ventricular cavity. This method is based on conventional color Doppler imaging, which makes iVFM compatible with the clinical setting. We have generalized the iVFM for a three-dimensional reconstruction (3D-iVFM). Approach. 3D-iVFM is able to recover three-component velocity vector fields in a full intraventricular volume by using a clinical echocardiographic triplane mode. The 3D-iVFM problem was written in the spherical (radial, polar, azimuthal) coordinate system associated to the six half-planes produced by the triplane mode. As with the 2D version, the method is based on the mass conservation, and free-slip boundary conditions on the endocardial wall. These mechanical constraints were imposed in a least-squares minimization problem that was solved through the method of Lagrange multipliers. We validated 3D-iVFM in silico in a patient-specific CFD (computational fluid dynamics) model of cardiac flow and tested its clinical feasibility in vivo in patients and in one volunteer. Main results. The radial and polar components of the velocity were recovered satisfactorily in the CFD setup (correlation coefficients,
r
= 0.99 and 0.78). The azimuthal components were estimated with larger errors (
r
= 0.57) as only six samples were available in this direction. In both in silico and in vivo investigations, the dynamics of the intraventricular vortex that forms during diastole was deciphered by 3D-iVFM. In particular, the CFD results showed that the mean vorticity can be estimated accurately by 3D-iVFM. Significance. Our results tend to indicate that 3D-iVFM could provide full-volume echocardiographic information on left intraventricular hemodynamics from the clinical modality of triplane color Doppler.
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28
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Strachinaru M, Voorneveld J, Keijzer LBH, Bowen DJ, Mutluer FO, Cate FT, de Jong N, Vos HJ, Bosch JG, van den Bosch AE. Left ventricular high frame rate echo-particle image velocimetry: clinical application and comparison with conventional imaging. Cardiovasc Ultrasound 2022; 20:11. [PMID: 35473581 PMCID: PMC9040345 DOI: 10.1186/s12947-022-00283-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Accepted: 04/11/2022] [Indexed: 11/17/2022] Open
Abstract
Background Echo-Particle Image Velocimetry (echoPIV) tracks speckle patterns from ultrasound contrast agent(UCA), being less angle-sensitive than colour Doppler. High frame rate (HFR) echoPIV enables tracking of high velocity flow in the left ventricle (LV). We aimed to demonstrate the potential clinical use of HFR echoPIV and investigate the feasibility and accuracy in patients. Methods Nineteen patients admitted for heart failure were included. HFR contrast images were acquired from an apical long axis view (ALAX), using a fully-programmable ultrasound system. A clinical UCA was continuously infused with a dedicated pump. Additionally, echocardiographic images were obtained using a clinical system, including LV contrast-enhanced images and pulsed-wave (PW) Doppler of the LV inflow and outflow in ALAX. 11 patients underwent CMR and 4 cardiac CT as clinically indicated. These CMR and CT images were used as reference. In 10 patients with good echoPIV tracking and reference imaging, the intracavitary flow was compared between echoPIV, conventional and UCA echocardiography. Results EchoPIV tracking quality was good in 12/19 (63%), moderate in 2/19 (10%) and poor in 5/19 (26%) subjects. EchoPIV could determine inflow velocity in 17/19 (89%), and outflow in 14/19 (74%) patients. The correlation of echoPIV and PW Doppler was good for the inflow (R2 = 0.77 to PW peak; R2 = 0.80 PW mean velocity) and moderate for the outflow (R2 = 0.54 to PW peak; R2 = 0.44 to PW mean velocity), with a tendency for echoPIV to underestimate PW velocities. In selected patients, echoPIV was able in a single acquisition to demonstrate flow patterns which required multiple interrogations with classical echocardiography. Those flow patterns could also be linked to anatomical abnormalities as seen in CMR or CT. Conclusion HFR echoPIV tracks multidirectional and complex flow patterns which are unapparent with conventional echocardiography, while having comparable feasibility. EchoPIV tends to underestimate flow velocities as compared to PW Doppler. It has the potential to provide in one acquisition all the functional information obtained by conventional imaging, overcoming the angle dependency of Doppler and low frame rate of classical contrast imaging. Supplementary Information The online version contains supplementary material available at 10.1186/s12947-022-00283-4.
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Affiliation(s)
- Mihai Strachinaru
- Department of Biomedical Engineering, Erasmus MC, Rotterdam, Netherlands. .,Department of Cardiology, Erasmus MC, Rotterdam, Netherlands.
| | - Jason Voorneveld
- Department of Biomedical Engineering, Erasmus MC, Rotterdam, Netherlands
| | - Lana B H Keijzer
- Department of Medical Physics, Spaarne Gasthuis, Haarlem, Netherlands.,Amsterdam UMC, Department of Radiology and Nuclear Medicine, Amsterdam, Netherlands
| | - Daniel J Bowen
- Department of Cardiology, Erasmus MC, Rotterdam, Netherlands
| | - Ferit O Mutluer
- Department of Cardiology, Erasmus MC, Rotterdam, Netherlands.,Yeditepe University Hospital, Department of Cardiology, Istanbul, Turkey
| | | | - Nico de Jong
- Department of Biomedical Engineering, Erasmus MC, Rotterdam, Netherlands
| | - Hendrik J Vos
- Department of Biomedical Engineering, Erasmus MC, Rotterdam, Netherlands
| | - Johan G Bosch
- Department of Biomedical Engineering, Erasmus MC, Rotterdam, Netherlands
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29
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Hasegawa H, Omura M, Nagaoka R. On the Investigation of Autocorrelation-Based Vector Doppler Method With Plane Wave Imaging. IEEE TRANSACTIONS ON ULTRASONICS, FERROELECTRICS, AND FREQUENCY CONTROL 2022; 69:1301-1311. [PMID: 35171769 DOI: 10.1109/tuffc.2022.3152186] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Although color flow imaging is one of the representative applications of the Doppler method, it can estimate only the velocity component in the direction of ultrasonic propagation, that is, the axial velocity component. The vector Doppler method with high-frame-rate plane wave imaging overcomes such a limitation by estimating the blood flow velocity vectors using the axial velocities obtained by emitting plane waves in multiple directions. The autocorrelation technique can be used for the estimation of the axial velocity using the phase shift of an ultrasonic echo signal between two transmit-receive events. The technique also requires the frequency of the received echo signal. Although the center frequency of the emitted ultrasonic signal is commonly used in the estimation of axial velocities, the center frequency should be estimated from the received signals. In this study, a method for the estimation of the center frequency designed particularly for the high-frame-rate plane wave imaging was developed. The proposed method estimates the wavenumbers of the received signal in lateral and vertical directions to estimate the wavenumber in the axial direction, from which the center frequency was estimated. The beam steering angle was also estimated from the wavenumbers in the two directions. The effect of the proposed method was validated in simulations. The absolute bias error (ABE) and root-mean squared error in estimated velocity vectors obtained by plane wave imaging with three beam steering angles (-15°, 0°, and 15°) were reduced from 9.27% and 14.80% to 1.15% and 8.75%, respectively, by the proposed method. The applicability of the proposed method to in vivo measurements was also demonstrated using the in vivo recordings of human common carotid arteries. Physiologically consistent blood flow velocity distributions were obtained with respect to three subjects using the proposed method.
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30
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Lan Z, Zheng C, Peng H, Qiao H. Adaptive scaled coherence factor for ultrasound pixel-based beamforming. ULTRASONICS 2022; 119:106608. [PMID: 34793999 DOI: 10.1016/j.ultras.2021.106608] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Revised: 09/21/2021] [Accepted: 09/28/2021] [Indexed: 06/13/2023]
Abstract
Synthetic aperture (SA) ultrasound imaging can obtain images with high-resolution owing to its ability to dynamically focus in both directions. The signal-to-noise ratio (SNR) of SA imaging is poor because the pulse energy using one array element is quite low. Thus, the SA method with bidirectional pixel-based focusing (SA-BiPBF) was previously proposed as a solution to this challenge. However, using the nonadaptive delay-and-sum (DAS) beamforming still limits its imaging performance. This study proposes an adaptive scaled coherence factor (AscCF) for SA-BiPBF to further boost the image quality. The AscCF exploits generalized coherence factor (GCF) to measure the signal coherence to adaptively adapt the parameters in SNR estimation rather than fixed ones. Comparisons were made with several other weighting techniques by performing simulations and experiments for performance evaluation. Results confirm that AscCF applied to SA-BiPBF offers a good image contrast while reservation of the speckle pattern. AscCF achieves maximal improvements of contrast ratio (CR) by 48.5% and 47.76 % compared with scaled coherence factor (scCF), respectively in simulation and experiment. Simultaneously, the maximum of improvements in speckle signal-to-noise ratio (sSNR) of AscCF are 11.28 % and 20.01 % upon scCF in simulation and experiment, respectively. From the in vivo result, it also appears a potential for AscCF to act in clinical situations to better detect lesion and retain speckle pattern.
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Affiliation(s)
- Zhengfeng Lan
- Department of Biomedical Engineering, Hefei University of Technology, Hefei, 230009, China
| | - Chichao Zheng
- Department of Biomedical Engineering, Hefei University of Technology, Hefei, 230009, China.
| | - Hu Peng
- Department of Biomedical Engineering, Hefei University of Technology, Hefei, 230009, China
| | - Heyuan Qiao
- Department of Biomedical Engineering, Hefei University of Technology, Hefei, 230009, China
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31
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Vixège F, Berod A, Sun Y, Mendez S, Bernard O, Ducros N, Courand PY, Nicoud F, Garcia D. Physics-constrained intraventricular vector flow mapping by color Doppler. Phys Med Biol 2021; 66. [PMID: 34874296 DOI: 10.1088/1361-6560/ac3ffe] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Accepted: 12/03/2021] [Indexed: 01/06/2023]
Abstract
Color Doppler by transthoracic echocardiography creates two-dimensional fan-shaped maps of blood velocities in the cardiac cavities. It is a one-component velocimetric technique since it only returns the velocity components parallel to the ultrasound beams. Intraventricular vector flow mapping (iVFM) is a method to recover the blood velocity vectors from the Doppler scalar fields in an echocardiographic three-chamber view. We improved ouriVFM numerical scheme by imposing physical constraints. TheiVFM consisted in minimizing regularized Doppler residuals subject to the condition that two fluid-dynamics constraints were satisfied, namely planar mass conservation, and free-slip boundary conditions. The optimization problem was solved by using the Lagrange multiplier method. A finite-difference discretization of the optimization problem, written in the polar coordinate system centered on the cardiac ultrasound probe, led to a sparse linear system. The single regularization parameter was determined automatically for non-supervision considerations. The physics-constrained method was validated using realistic intracardiac flow data from a patient-specific computational fluid dynamics (CFD) model. The numerical evaluations showed that theiVFM-derived velocity vectors were in very good agreement with the CFD-based original velocities, with relative errors ranged between 0.3% and 12%. We calculated two macroscopic measures of flow in the cardiac region of interest, the mean vorticity and mean stream function, and observed an excellent concordance between physics-constrainediVFM and CFD. The capability of physics-constrainediVFM was finally tested within vivocolor Doppler data acquired in patients routinely examined in the echocardiographic laboratory. The vortex that forms during the rapid filling was deciphered. The physics-constrainediVFM algorithm is ready for pilot clinical studies and is expected to have a significant clinical impact on the assessment of diastolic function.
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Affiliation(s)
- Florian Vixège
- CREATIS UMR 5220, U1294, University Lyon 1, INSA Lyon, France
| | - Alain Berod
- IMAG UMR 5149, University of Montpellier, France
| | - Yunyun Sun
- CREATIS UMR 5220, U1294, University Lyon 1, INSA Lyon, France
| | - Simon Mendez
- IMAG UMR 5149, University of Montpellier, France
| | - Olivier Bernard
- CREATIS UMR 5220, U1294, University Lyon 1, INSA Lyon, France
| | - Nicolas Ducros
- CREATIS UMR 5220, U1294, University Lyon 1, INSA Lyon, France
| | - Pierre-Yves Courand
- CREATIS UMR 5220, U1294, University Lyon 1, INSA Lyon, France.,Department of Echocardiography, Croix-Rousse Hospital, Lyon, France
| | | | - Damien Garcia
- CREATIS UMR 5220, U1294, University Lyon 1, INSA Lyon, France
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32
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Evaluation of intraventricular flow by multimodality imaging: a review and meta-analysis. Cardiovasc Ultrasound 2021; 19:38. [PMID: 34876127 PMCID: PMC8653587 DOI: 10.1186/s12947-021-00269-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Accepted: 11/18/2021] [Indexed: 11/19/2022] Open
Abstract
Background The aim of this systematic review was to evaluate current inter-modality agreement of noninvasive clinical intraventricular flow (IVF) assessment with 3 emerging imaging modalities: echocardiographic particle image velocimetry (EPIV), vector flow mapping (VFM), and 4-dimensional flow cardiovascular magnetic resonance imaging (4D flow CMR). Methods We performed a systematic literature review in the databases EMBASE, Medline OVID and Cochrane Central for identification of studies evaluating left ventricular (LV) flow patterns using one of these flow visualization modalities. Of the 2224 initially retrieved records, 10 EPIV, 23 VFM, and 25 4D flow CMR studies were included in the final analysis. Results Vortex parameters were more extensively studied with EPIV, while LV energetics and LV transport mechanics were mainly studied with 4D flow CMR, and LV energy loss and vortex circulation were implemented by VFM studies. Pooled normative values are provided for these parameters. The meta- analysis for the values of two vortex morphology parameters, vortex length and vortex depth, failed to reveal a significant change between heart failure patients and healthy controls. Conclusion Agreement between the different modalities studying intraventricular flow is low and different methods of measurement and reporting were used among studies. A multimodality framework with a standardized set of flow parameters is necessary for implementation of noninvasive flow visualization in daily clinical practice. The full potential of noninvasive flow visualization in addition to diagnostics could also include guiding medical or interventional treatment. Supplementary Information The online version contains supplementary material available at 10.1186/s12947-021-00269-8.
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33
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Daae AS, Wigen MS, Fadnes S, Løvstakken L, Støylen A. Intraventricular Vector Flow Imaging with Blood Speckle Tracking in Adults: Feasibility, Normal Physiology and Mechanisms in Healthy Volunteers. ULTRASOUND IN MEDICINE & BIOLOGY 2021; 47:3501-3513. [PMID: 34620522 DOI: 10.1016/j.ultrasmedbio.2021.08.021] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Revised: 08/24/2021] [Accepted: 08/29/2021] [Indexed: 06/13/2023]
Abstract
This study examines the feasibility of blood speckle tracking for vector flow imaging in healthy adults and describes the physiologic flow pattern and vortex formation in relation to the wall motion in the left ventricle. The study included 21 healthy volunteers and quantified and visualized flow patterns with high temporal resolution down to a depth of 10-12 cm without the use of contrast agents. Intraventricular flow seems to originate during the isovolumetric relaxation with a propagation of blood from base to apex. With the E-wave, rapid inflow and vortex formation occurred on both sides of the valve basally. During diastasis the flow gathers in a large vortex before the pattern from the E-wave repeats during the A-wave. In isovolumetric contraction, the flow again gathers in a large vortex that seems to facilitate the flow out in the aorta during systole. No signs of a persistent systolic vortex were visualized. The geometry of the left ventricle and the movement of the AV-plane is important in creating vortices that are favorable for the blood flow and facilitate outflow. The quantitative measurements are in concordance with these findings, but the clinical interpretation must be evaluated in future clinical studies.
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Affiliation(s)
- Annichen Søyland Daae
- Department of Circulation and Medical Imaging, Norwegian University of Science and Technology, Trondheim, Norway; Department of Cardiology, St. Olav Hospital/Trondheim University Hospital, Trondheim, Norway.
| | - Morten Smedsrud Wigen
- Department of Circulation and Medical Imaging, Norwegian University of Science and Technology, Trondheim, Norway
| | - Solveig Fadnes
- Department of Circulation and Medical Imaging, Norwegian University of Science and Technology, Trondheim, Norway; Møre og Romsdal Hospital Trust, Women's Health, Child and Adolescent Clinic, Ålesund Hospital, Ålesund, Norway
| | - Lasse Løvstakken
- Department of Circulation and Medical Imaging, Norwegian University of Science and Technology, Trondheim, Norway
| | - Asbjørn Støylen
- Department of Circulation and Medical Imaging, Norwegian University of Science and Technology, Trondheim, Norway; Department of Cardiology, St. Olav Hospital/Trondheim University Hospital, Trondheim, Norway
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34
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Marchese P, Cantinotti M, Van den Eynde J, Assanta N, Franchi E, Pak V, Santoro G, Koestenberger M, Kutty S. Left ventricular vortex analysis by high-frame rate blood speckle tracking echocardiography in healthy children and in congenital heart disease. IJC HEART & VASCULATURE 2021; 37:100897. [PMID: 34786451 PMCID: PMC8579140 DOI: 10.1016/j.ijcha.2021.100897] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2021] [Revised: 10/14/2021] [Accepted: 10/15/2021] [Indexed: 11/29/2022]
Abstract
Background High-frame rate blood speckle tracking (BST) echocardiography is a new technique for the assessment of intracardiac flow. The purpose of this study was to evaluate the characteristics of left ventricular (LV) vortices in healthy children and in those with congenital heart disease (CHD). Methods Characteristics of LV vortices were analyses based on 4-chamber BST images from 118 healthy children (median age 6.84 years, range 0.01-17 years) and 43 children with CHD (median age 0.99 years, range 0.01-14 years). Both groups were compared after propensity matching. Multiple linear regression was used to identify factors that independently influence vortex characteristics. Results Feasibility of vortex imaging was 93.7% for healthy children and 95.6% for CHD. After propensity matching, there were no overall significant differences in vortex distance to apex, distance to interventricular septum (IVS), height, width, sphericity index, or area. However, multiple regression analysis revealed significant associations of LV morphology with vortex characteristics. Furthermore, CHD involving LV volume overload and CHD involving LV pressure overload were both associated with vortices localized closer to the IVS. Conclusions LV vortex analysis using high-frame rate BST echocardiography is feasible in healthy children and in those with CHD. As they are associated with LV morphology and are modified in some types of CHD, vortices might yield diagnostic and prognostic value. Future studies are warranted to establish applications of vortex imaging in the clinical setting.
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Key Words
- -i, indexed to BSA
- AV, atrioventricular
- BMI, body mass index
- BSA, body surface area
- BST, blood speckle tracking
- Blood speckle imaging
- Bpm, beats per minute
- CHD, congenital heart disease
- CI, correlation index
- Congenital
- ED, end-diastolic
- Echocardiography
- Fps, frame per second
- Heart defects
- ICC, intraclass correlation coefficient
- IQR, interquartile range
- IVS, interventricular septum
- LV, left ventricle/ventricular
- LVEDA, left ventricular end-diastolic area
- LVEDD, left ventricular end-diastolic dimension
- LVEDV, left ventricular end-diastolic volume
- LVEF, left ventricular ejection fraction
- LVESD, left ventricular end-systolic dimension
- LVESV, left ventricular end-systolic volume
- LVOT, left ventricular outflow tract
- LVPO, CHD involving left ventricle pressure overload
- LVSV, left ventricular stroke volume
- LVVO, CHD involving left ventricular volume overload
- Left ventricle
- MV, mitral valve
- Pediatrics
- RVPO, CHD involving right ventricular pressure overload
- RVVO, CHD involving right ventricular volume overload
- TGA, transposition of the great arteries
- Vortex imaging
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Affiliation(s)
- Pietro Marchese
- Fondazione G. Monasterio CNR-Regione Toscana, Massa and Pisa, Italy.,Adult Institute of Clinical Physiology, Pisa, Italy
| | | | - Jef Van den Eynde
- Taussig Heart Center, Department of Pediatrics, Johns Hopkins Hospital, Baltimore, MD, USA.,Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium
| | - Nadia Assanta
- Fondazione G. Monasterio CNR-Regione Toscana, Massa and Pisa, Italy
| | - Eliana Franchi
- Fondazione G. Monasterio CNR-Regione Toscana, Massa and Pisa, Italy
| | - Vitali Pak
- Fondazione G. Monasterio CNR-Regione Toscana, Massa and Pisa, Italy
| | - Giuseppe Santoro
- Fondazione G. Monasterio CNR-Regione Toscana, Massa and Pisa, Italy
| | | | - Shelby Kutty
- Taussig Heart Center, Department of Pediatrics, Johns Hopkins Hospital, Baltimore, MD, USA
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Loke YH, Capuano F, Cleveland V, Mandell JG, Balaras E, Olivieri LJ. Moving beyond size: vorticity and energy loss are correlated with right ventricular dysfunction and exercise intolerance in repaired Tetralogy of Fallot. J Cardiovasc Magn Reson 2021; 23:98. [PMID: 34412634 PMCID: PMC8377822 DOI: 10.1186/s12968-021-00789-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Accepted: 06/28/2021] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND The global effect of chronic pulmonary regurgitation (PR) on right ventricular (RV) dilation and dysfunction in repaired Tetralogy of Fallot (rTOF) patients is well studied by cardiovascular magnetic resonance (CMR). However, the links between PR in the RV outflow tract (RVOT), RV dysfunction and exercise intolerance are not clarified by conventional measurements. Not all patients with RV dilation share the same intracardiac flow characteristics, now measurable by time resolved three-dimensional phase contrast imaging (4D flow). In our study, we quantified regional vorticity and energy loss in rTOF patients and correlated these parameters with RV dysfunction and exercise capacity. METHODS rTOF patients with 4D flow datasets were retrospectively analyzed, including those with transannular/infundibular repair and conduit repair. Normal controls and RV dilation patients with atrial-level shunts (Qp:Qs > 1.2:1) were included for comparison. 4D flow was post-processed using IT Flow (Cardioflow, Japan). Systolic/diastolic vorticity (ω, 1/s) and viscous energy loss (VEL, mW) in the RVOT and RV inflow were measured. To characterize the relative influence of diastolic vorticity in the two regions, an RV Diastolic Vorticity Quotient (ωRVOT-Diastole/ωRV Inflow-Diastole, RV-DVQ) was calculated. Additionally, RVOT Vorticity Quotient (ωRVOT-Diastole/ωRVOT-Systole, RVOT-VQ) and RVOT Energy Quotient (VELRVOT-Diastole/VELRVOT-Systole, RVOT-EQ) was calculated. In rTOF, measurements were correlated against conventional CMR and exercise stress test results. RESULTS 58 rTOF patients, 28 RV dilation patients and 12 controls were included. RV-DVQ, RVOT-VQ, and RVOT-EQ were highest in rTOF patients with severe PR compared to rTOF patients with non-severe PR, RV dilation and controls (p < 0.001). RV-DVQ positively correlated with RV end-diastolic volume (0.683, p < 0.001), PR fraction (0.774, p < 0.001) and negatively with RV ejection fraction (- 0.521, p = 0.003). Both RVOT-VQ, RVOT-EQ negatively correlated with VO2-max (- 0.587, p = 0.008 and - 0.617, p = 0.005) and % predicted VO2-max (- 0.678, p = 0.016 and - 0.690, p = 0.001). CONCLUSIONS In rTOF patients, vorticity and energy loss dominate the RVOT compared to tricuspid inflow, correlating with RV dysfunction and exercise intolerance. These 4D flow-based measurements may be sensitive biomarkers to guide surgical management of rTOF patients.
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Affiliation(s)
- Yue-Hin Loke
- Division of Cardiology, Children's National Medical Center, 111 Michigan Ave NW, W3-200, Washington, DC, 20010, USA.
| | - Francesco Capuano
- Department of Mechanics, Mathematics and Management, Polytechnic University of Bari, Bari, Italy
| | - Vincent Cleveland
- Sheikh Zayed Institute for Pediatric Surgical Innovation, Children's National Medical Center, 111 Michigan Ave NW, Washington, DC, 20010, USA
| | - Jason G Mandell
- Division of Cardiology, Children's National Medical Center, 111 Michigan Ave NW, W3-200, Washington, DC, 20010, USA
| | - Elias Balaras
- Department of Mechanical and Aerospace Engineering, George Washington University, Washington, DC, 20052, USA
| | - Laura J Olivieri
- Division of Cardiology, Children's National Medical Center, 111 Michigan Ave NW, W3-200, Washington, DC, 20010, USA
- Sheikh Zayed Institute for Pediatric Surgical Innovation, Children's National Medical Center, 111 Michigan Ave NW, Washington, DC, 20010, USA
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Rossi S, Ramalli A, Tortoli P. On the Depth-Dependent Accuracy of Plane-Wave-Based Vector Velocity Measurements With Linear Arrays. IEEE TRANSACTIONS ON ULTRASONICS, FERROELECTRICS, AND FREQUENCY CONTROL 2021; 68:2707-2715. [PMID: 33909562 DOI: 10.1109/tuffc.2021.3076284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
High-frame-rate vector Doppler methods are used to measure blood velocities over large 2-D regions, but their accuracy is often estimated over a short range of depths. This article thoroughly examines the dependence of velocity measurement accuracy on the target position. Simulations were carried out on flat and parabolic flow profiles, for different Doppler angles, and considering a 2-D vector flow imaging (2-D VFI) method based on plane wave transmission and speckle tracking. The results were also compared with those obtained by the reference spectral Doppler (SD) method. Although, as expected, the bias and standard deviation generally tend to worsen at increasing depths, the measurements also show the following. First, the errors are much lower for the flat profile (from ≈ -4 ± 3% at 20 mm to ≈ -17 ± 4% at 100 mm) than for the parabolic profile (from ≈ -4 ± 3% to ≈ -38 ±%). Second, only part of the relative estimation error is related to the inherent low resolution of the 2-D VFI method. For example, even for SD, the error bias increases (on average) from -0.7% (20 mm) to -17% (60 mm) up to -26% (100 mm). Third, conversely, the beam divergence associated with the linear array acoustic lens was found to have a great impact on the velocity measurements. By simply removing such lens, the average bias for 2-D VFI at 60 and 100 mm dropped down to -9.4% and -19.4%, respectively. In conclusion, the results indicate that the transmission beam broadening on the elevation plane, which is not limited by reception dynamic focusing, is the main cause of velocity underestimation in the presence of high spatial gradients.
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Measurement of flow velocity vectors in carotid artery using plane wave imaging with repeated transmit sequence. J Med Ultrason (2001) 2021; 48:417-427. [PMID: 34287752 DOI: 10.1007/s10396-021-01113-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Accepted: 06/17/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE Doppler-based methods are widely used for blood flow imaging in clinical settings. However, they inherently estimate the velocity component only in the axial direction. Therefore, various studies of angle-independent methods have been conducted. The multi-angle Doppler method is one such angle-independent method, in which the velocity vector is estimated using axial velocities obtained from multiple directions by steering an ultrasonic beam. Recently, plane wave imaging, which realizes a very high frame rate of several thousand frames per second, was applied to the multi-angle Doppler method. However, the maximum detectable velocity, i.e., the aliasing limit, was reduced depending on the number of steering angles. In the present study, the feasibility of a specific transmit sequence, namely, the repeated transmit sequence, was examined using the plane-wave multi-angle Doppler method. METHOD In the repeated transmit sequence, plane waves were emitted to the same direction twice, after which the steering angle was changed. By repeating the same procedure, a pair of beamformed radio-frequency (RF) signals could be obtained under each beam steering angle. By applying the autocorrelation method to each pair of RF signals, the time interval between the RF signals could be kept as the pulse repetition interval (PRI). The feasibility of such a transmit sequence was examined by numerical simulation and in vivo measurement of a human carotid artery. RESULTS The simulation results showed that the maximum steering angles of over 10 degrees were not feasible with the linear array used in the present study. The feasible maximum steering angle would depend on the element pitch of the probe relative to the ultrasonic wavelength. By limiting the maximum steering angles to 5 and 10 degrees, bias errors were 9.2% and 11.3%, respectively, and root mean squared errors were 21.5% and 16.9%, respectively. Also, flow velocity vectors in a human carotid artery could be visualized with the proposed method. CONCLUSION The multi-angle Doppler method was implemented in plane wave imaging with the repeated transmit sequence, and the proposed method was shown to be feasible through numerical simulation and in vivo measurement of a carotid artery.
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Avesani M, Degrelle B, Di Salvo G, Thambo JB, Iriart X. Vector flow mapping: A review from theory to practice. Echocardiography 2021; 38:1405-1413. [PMID: 34259359 DOI: 10.1111/echo.15154] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Revised: 06/19/2021] [Accepted: 07/01/2021] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND The interest in intra-cardiac blood flow analysis is rapidly growing, and it has encouraged the development of different non-invasive imaging techniques. Among these, Vector Flow Mapping (VFM), combing Color-Doppler imaging and speckle tracking data, seems to be a promising approach, feasible in adult and children population. AIM OF THE REVIEW The aim of this review is to give a historical perspective on the development of VFM method and a summary of the current algorithms and parameters potentially evaluable. Then, we will present the current state-of-the-art of VFM with an overview of clinical studies and applications of this technique.
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Affiliation(s)
- Martina Avesani
- Department of Pediatric and Adult Congenital Cardiology, Bordeaux University Hospital (CHU), Pessac, France.,Department of Women's and Children's Health, University of Padua, Padua, Italy
| | - Bastien Degrelle
- Department of Pediatric and Adult Congenital Cardiology, Bordeaux University Hospital (CHU), Pessac, France
| | - Giovanni Di Salvo
- Department of Women's and Children's Health, University of Padua, Padua, Italy
| | - Jean-Benoit Thambo
- Department of Pediatric and Adult Congenital Cardiology, Bordeaux University Hospital (CHU), Pessac, France.,Electrophysiology and Heart Modeling Institute, IHU Liryc, Fondation Bordeaux Université, Bordeaux, France.,Centre de recherche Cardio-Thoracique de Bordeaux, INSERM, Bordeaux, France
| | - Xavier Iriart
- Department of Pediatric and Adult Congenital Cardiology, Bordeaux University Hospital (CHU), Pessac, France.,Electrophysiology and Heart Modeling Institute, IHU Liryc, Fondation Bordeaux Université, Bordeaux, France.,Centre de recherche Cardio-Thoracique de Bordeaux, INSERM, Bordeaux, France
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Voorneveld J, Keijzer LBH, Strachinaru M, Bowen DJ, Mutluer FO, van der Steen AFW, Cate FJT, de Jong N, Vos HJ, van den Bosch AE, Bosch JG. Optimization of Microbubble Concentration and Acoustic Pressure for Left Ventricular High-Frame-Rate EchoPIV in Patients. IEEE TRANSACTIONS ON ULTRASONICS, FERROELECTRICS, AND FREQUENCY CONTROL 2021; 68:2432-2443. [PMID: 33720832 DOI: 10.1109/tuffc.2021.3066082] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
High-frame-rate (HFR) echo-particle image velocimetry (echoPIV) is a promising tool for measuring intracardiac blood flow dynamics. In this study, we investigate the optimal ultrasound contrast agent (UCA: SonoVue) infusion rate and acoustic output to use for HFR echoPIV (PRF = 4900 Hz) in the left ventricle (LV) of patients. Three infusion rates (0.3, 0.6, and 1.2 ml/min) and five acoustic output amplitudes (by varying transmit voltage: 5, 10, 15, 20, and 30 V-corresponding to mechanical indices of 0.01, 0.02, 0.03, 0.04, and 0.06 at 60-mm depth) were tested in 20 patients admitted for symptoms of heart failure. We assess the accuracy of HFR echoPIV against pulsed-wave Doppler acquisitions obtained for mitral inflow and aortic outflow. In terms of image quality, the 1.2-ml/min infusion rate provided the highest contrast-to-background ratio (CBR) (3-dB improvement over 0.3 ml/min). The highest acoustic output tested resulted in the lowest CBR. Increased acoustic output also resulted in increased microbubble disruption. For the echoPIV results, the 1.2-ml/min infusion rate provided the best vector quality and accuracy; mid-range acoustic outputs (corresponding to 15-20-V transmit voltages) provided the best agreement with the pulsed-wave Doppler. Overall, the highest infusion rate (1.2 ml/min) and mid-range acoustic output amplitudes provided the best image quality and echoPIV results.
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40
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Development of Custom Wall-Less Cardiovascular Flow Phantoms with Tissue-Mimicking Gel. Cardiovasc Eng Technol 2021; 13:1-13. [PMID: 34080171 PMCID: PMC8888498 DOI: 10.1007/s13239-021-00546-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Accepted: 05/12/2021] [Indexed: 10/26/2022]
Abstract
PURPOSE Flow phantoms are used in experimental settings to aid in the simulation of blood flow. Custom geometries are available, but current phantom materials present issues with degradability and/or mimicking the mechanical properties of human tissue. In this study, a method of fabricating custom wall-less flow phantoms from a tissue-mimicking gel using 3D printed inserts is developed. METHODS A 3D blood vessel geometry example of a bifurcated artery model was 3D printed in polyvinyl alcohol, embedded in tissue-mimicking gel, and subsequently dissolved to create a phantom. Uniaxial compression testing was performed to determine the Young's moduli of the five gel types. Angle-independent, ultrasound-based imaging modalities, Vector Flow Imaging (VFI) and Blood Speckle Imaging (BSI), were utilized for flow visualization of a straight channel phantom. RESULTS A wall-less phantom of the bifurcated artery was fabricated with minimal bubbles and continuous flow demonstrated. Additionally, flow was visualized through a straight channel phantom by VFI and BSI. The available gel types are suitable for mimicking a variety of tissue types, including cardiac tissue and blood vessels. CONCLUSION Custom, tissue-mimicking flow phantoms can be fabricated using the developed methodology and have potential for use in a variety of applications, including ultrasound-based imaging methods. This is the first reported use of BSI with an in vitro flow phantom.
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Guidi F, Tortoli P. Real-Time High Frame Rate Color Flow Mapping System. IEEE TRANSACTIONS ON ULTRASONICS, FERROELECTRICS, AND FREQUENCY CONTROL 2021; 68:2193-2201. [PMID: 33690116 DOI: 10.1109/tuffc.2021.3064612] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Plane wave (PW) transmission (TX) can be profitably used to improve the performance of color flow mapping (CFM) systems by increasing the autocorrelation ensemble length (EL) and/or the frame rate (FR). Although high-end scanners tend to include imaging schemes using PW TX and parallel receive beams, high frame rate (HFR) CFM has been so far experimentally implemented mostly through research platforms that transmit PWs and beamform/process the received channel data off-line. In this article, full real-time implementation of PW CFM with continuous-time clutter filtering and extended FR/EL is reported. The field-programmable gate arrays (FPGAs) and digital signal processors (DSPs) onboard the ULA-OP 256 research scanner were programmed to perform high-speed parallel beamforming and autocorrelation-based CFM processing, respectively. Different strategies were tested, in which the TX of PWs for CFM is either continuous or interleaved with the TX of packets of B-mode pulses. A fourth-order Chebyshev continuous-time high-pass filter with programmable cutoff frequency was implemented and its clutter rejection performance was positively compared with that obtained when operating on packet data. CFM FRs up to 575 were obtained. The possibility of programming the autocorrelation EL up to 64 permitted to detect flow with high sensitivity and accuracy (average relative errors down to 0.4% ± 8.4%). In vivo HFR movies are presented, showing the dynamics of flow in the common carotid artery, which highlight the presence of secondary flow components.
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Mawad W, Løvstakken L, Fadnes S, Grønli T, Segers P, Mertens L, Nyrnes SA. Right Ventricular Flow Dynamics in Dilated Right Ventricles: Energy Loss Estimation Based on Blood Speckle Tracking Echocardiography-A Pilot Study in Children. ULTRASOUND IN MEDICINE & BIOLOGY 2021; 47:1514-1527. [PMID: 33685744 DOI: 10.1016/j.ultrasmedbio.2021.02.004] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Revised: 12/24/2020] [Accepted: 02/06/2021] [Indexed: 06/12/2023]
Abstract
Using blood speckle tracking (BST) based on high-frame-rate echocardiography (HFRE), we compared right ventricle (RV) flow dynamics in children with atrial septal defects (ASDs) and repaired tetralogy of Fallot (rTOF). Fifty-seven children with rTOF with severe pulmonary insufficiency (PI) (n = 21), large ASDs (n = 11) and healthy controls (CTL, n = 25) were included. Using a flow phantom, we studied the effects of imaging plane and smoothing parameters on 2-D energy loss (EL). RV diastolic EL was similar in ASD and rTOF, but both were greater than in CTL. Locations of high EL were similar in all groups in systole, occurring in the RV outflow tract and around the tricuspid valve leaflets in early diastole. An additional apical early diastolic area of EL was noted in rTOF, corresponding to colliding tricuspid inflow and PI. The flow phantom revealed that EL varied with imaging plane and smoothing settings but that the EL trend was preserved if kept consistent.
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Affiliation(s)
- Wadi Mawad
- The Hospital for Sick Children, Toronto, Ontario, Canada; Department of Circulation and Medical Imaging, Norwegian University of Science and Technology (NTNU), Trondheim, Norway; Department of Paediatrics, Montreal Children's Hospital, McGill University Health Centre, Montreal, Quebec, Canada.
| | - Lasse Løvstakken
- Department of Circulation and Medical Imaging, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - Solveig Fadnes
- Department of Circulation and Medical Imaging, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - Thomas Grønli
- Department of Circulation and Medical Imaging, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | | | - Luc Mertens
- The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Siri Ann Nyrnes
- Department of Circulation and Medical Imaging, Norwegian University of Science and Technology (NTNU), Trondheim, Norway; Children's Clinic, St. Olav's University Hospital, Trondheim, Norway
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Blood Flow Quantification in Peripheral Arterial Disease: Emerging Diagnostic Techniques in Vascular Surgery. Surg Technol Int 2021. [PMID: 33970476 DOI: 10.52198/21.sti.38.cv1410] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
The assessment of local blood flow patterns in patients with peripheral arterial disease is clinically relevant, since these patterns are related to atherosclerotic disease progression and loss of patency in stents placed in peripheral arteries, through mechanisms such as recirculating flow and low wall shear stress (WSS). However, imaging of vascular flow in these patients is technically challenging due to the often complex flow patterns that occur near atherosclerotic lesions. While several flow quantification techniques have been developed that could improve the outcomes of vascular interventions, accurate 2D or 3D blood flow quantification is not yet used in clinical practice. This article provides an overview of several important topics that concern the quantification of blood flow in patients with peripheral arterial disease. The hemodynamic mechanisms involved in the development of atherosclerosis and the current clinical practice in the diagnosis of this disease are discussed, showing the unmet need for improved and validated flow quantification techniques in daily clinical practice. This discussion is followed by a showcase of state-of-the-art blood flow quantification techniques and how these could be used before, during and after treatment of stenotic lesions to improve clinical outcomes. These techniques include novel ultrasound-based methods, Phase-Contrast Magnetic Resonance Imaging (PC-MRI) and Computational Fluid Dynamics (CFD). The last section discusses future perspectives, with advanced (hybrid) imaging techniques and artificial intelligence, including the implementation of these techniques in clinical practice.
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Engelhard S, van de Velde L, Jebbink E, Jain K, Westenberg J, Zeebregts C, Versluis M, Reijnen M. Blood Flow Quantification in Peripheral Arterial Disease: Emerging Diagnostic Techniques in Vascular Surgery. Surg Technol Int 2021. [DOI: https:/doi.org/10.52198/21.sti.38.cv1410] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2023]
Abstract
The assessment of local blood flow patterns in patients with peripheral arterial disease is clinically relevant, since these patterns are related to atherosclerotic disease progression and loss of patency in stents placed in peripheral arteries, through mechanisms such as recirculating flow and low wall shear stress (WSS). However, imaging of vascular flow in these patients is technically challenging due to the often complex flow patterns that occur near atherosclerotic lesions. While several flow quantification techniques have been developed that could improve the outcomes of vascular interventions, accurate 2D or 3D blood flow quantification is not yet used in clinical practice. This article provides an overview of several important topics that concern the quantification of blood flow in patients with peripheral arterial disease. The hemodynamic mechanisms involved in the development of atherosclerosis and the current clinical practice in the diagnosis of this disease are discussed, showing the unmet need for improved and validated flow quantification techniques in daily clinical practice. This discussion is followed by a showcase of state-of-the-art blood flow quantification techniques and how these could be used before, during and after treatment of stenotic lesions to improve clinical outcomes. These techniques include novel ultrasound-based methods, Phase-Contrast Magnetic Resonance Imaging (PC-MRI) and Computational Fluid Dynamics (CFD). The last section discusses future perspectives, with advanced (hybrid) imaging techniques and artificial intelligence, including the implementation of these techniques in clinical practice.
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Affiliation(s)
- Stefan Engelhard
- Department of Vascular Surgery, Rijnstate, Arnhem, The Netherlands
| | | | - Erik Jebbink
- Department of Vascular Surgery, Rijnstate, Arnhem, The Netherlands
| | - Kartik Jain
- Department of Thermal and Fluid Engineering, University of Twente, Enschede, The Netherlands
| | - Jos Westenberg
- Department of Radiology, Cardiovascular Imaging Group, Leiden University Medical Center, Leiden, The Netherlands
| | - Clark Zeebregts
- Department of Surgery (Division of Vascular Surgery), University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Michel Versluis
- Physics of Fluids Group, Technical Medical (TechMed) Centre, University of Twente, Enschede, The Netherlands
| | - Michel Reijnen
- Department of Vascular Surgery, Rijnstate, Arnhem, The Netherlands
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Lan Z, Jin L, Feng S, Zheng C, Han Z, Peng H. Joint Generalized Coherence Factor and Minimum Variance Beamformer for Synthetic Aperture Ultrasound Imaging. IEEE TRANSACTIONS ON ULTRASONICS, FERROELECTRICS, AND FREQUENCY CONTROL 2021; 68:1167-1183. [PMID: 33141664 DOI: 10.1109/tuffc.2020.3035412] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
The delay-and-sum (DAS) beamformer is the most commonly used method in medical ultrasound imaging. Compared with the DAS beamformer, the minimum variance (MV) beamformer has an excellent ability to improve lateral resolution by minimizing the output of interference and noise power. However, it is hard to overcome the tradeoff between satisfactory lateral resolution and speckle preservation performance due to the fixed subarray length of covariance matrix estimation. In this study, a new approach for MV beamforming with adaptive spatial smoothing is developed to address this problem. In the new approach, the generalized coherence factor (GCF) is used as a local coherence detection tool to adaptively determine the subarray length for spatial smoothing, which is called adaptive spatial-smoothed MV (AMV). Furthermore, another adaptive regional weighting strategy based on the local signal-to-noise ratio (SNR) and GCF is devised for AMV to enhance the image contrast, which is called GCF regional weighted AMV (GAMV). To evaluate the performance of the proposed methods, we compare them with the standard MV by conducting the simulation, in vitro experiment, and the in vivo rat mammary tumor study. The results show that the proposed methods outperform MV in speckle preservation without an appreciable loss in lateral resolution. Moreover, GAMV offers excellent performance in image contrast. In particular, AMV can achieve maximal improvements of speckle signal-to-noise ratio (SNR) by 96.19% (simulation) and 62.82% (in vitro) compared with MV. GAMV achieves improvements of contrast-to-noise ratio by 27.16% (simulation) and 47.47% (in vitro) compared with GCF. Meanwhile, the losses in lateral resolution of AMV are 0.01 mm (simulation) and 0.17 mm (in vitro) compared with MV. Overall, this indicates that the proposed methods can effectively address the inherent limitation of the standard MV in order to improve the image quality.
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Carvalho V, Gonçalves IM, Souza A, Souza MS, Bento D, Ribeiro JE, Lima R, Pinho D. Manual and Automatic Image Analysis Segmentation Methods for Blood Flow Studies in Microchannels. MICROMACHINES 2021; 12:mi12030317. [PMID: 33803615 PMCID: PMC8002955 DOI: 10.3390/mi12030317] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/20/2021] [Revised: 03/12/2021] [Accepted: 03/14/2021] [Indexed: 01/16/2023]
Abstract
In blood flow studies, image analysis plays an extremely important role to examine raw data obtained by high-speed video microscopy systems. This work shows different ways to process the images which contain various blood phenomena happening in microfluidic devices and in microcirculation. For this purpose, the current methods used for tracking red blood cells (RBCs) flowing through a glass capillary and techniques to measure the cell-free layer thickness in different kinds of microchannels will be presented. Most of the past blood flow experimental data have been collected and analyzed by means of manual methods, that can be extremely reliable, but they are highly time-consuming, user-intensive, repetitive, and the results can be subjective to user-induced errors. For this reason, it is crucial to develop image analysis methods able to obtain the data automatically. Concerning automatic image analysis methods for individual RBCs tracking and to measure the well known microfluidic phenomena cell-free layer, two developed methods are presented and discussed in order to demonstrate their feasibility to obtain accurate data acquisition in such studies. Additionally, a comparison analysis between manual and automatic methods was performed.
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Affiliation(s)
- Violeta Carvalho
- Mechanical Engineering and Resource Sustainability Center (MEtRICs), Mechanical Engineering Department, University of Minho, 4800-058 Guimarães, Portugal; (V.C.); (D.P.)
| | - Inês M. Gonçalves
- Instituto Superior Técnico, Universidade de Lisboa, Av. Rovisco Pais, 1049-001 Lisboa, Portugal;
| | - Andrews Souza
- Centro para a Valorização de Resíduos (CVR), University of Minho, 4800-028 Guimarães, Portugal;
| | - Maria S. Souza
- Center for MicroElectromechanical Systems (CMEMS), University of Minho, 4800-058 Guimarães, Portugal;
| | - David Bento
- Transport Phenomena Research Center (CEFT), Faculdade de Engenharia da Universidade do Porto (FEUP), Rua Dr. Roberto Frias, 4200-465 Porto, Portugal;
- Polytechnic Institute of Bragança, ESTiG/IPB, C. Sta. Apolónia, 5300-857 Bragança, Portugal;
| | - João E. Ribeiro
- Polytechnic Institute of Bragança, ESTiG/IPB, C. Sta. Apolónia, 5300-857 Bragança, Portugal;
- Centro de Investigação de Montanha (CIMO), Polytechnic Institute of Bragança, 5300-252, Bragança, Portugal
| | - Rui Lima
- Mechanical Engineering and Resource Sustainability Center (MEtRICs), Mechanical Engineering Department, University of Minho, 4800-058 Guimarães, Portugal; (V.C.); (D.P.)
- Transport Phenomena Research Center (CEFT), Faculdade de Engenharia da Universidade do Porto (FEUP), Rua Dr. Roberto Frias, 4200-465 Porto, Portugal;
- Correspondence:
| | - Diana Pinho
- Mechanical Engineering and Resource Sustainability Center (MEtRICs), Mechanical Engineering Department, University of Minho, 4800-058 Guimarães, Portugal; (V.C.); (D.P.)
- Center for MicroElectromechanical Systems (CMEMS), University of Minho, 4800-058 Guimarães, Portugal;
- Polytechnic Institute of Bragança, ESTiG/IPB, C. Sta. Apolónia, 5300-857 Bragança, Portugal;
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47
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Cantinotti M, Marchese P, Koestenberger M, Giordano R, Santoro G, Assanta N, Kutty S. Intracardiac flow visualization using high-frame rate blood speckle tracking echocardiography: Illustrations from infants with congenital heart disease. Echocardiography 2021; 38:707-715. [PMID: 33729605 DOI: 10.1111/echo.15009] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Accepted: 02/08/2021] [Indexed: 12/21/2022] Open
Abstract
We report applications of novel high-frame rate blood speckle tracking (BST) echocardiography in a series of infants with congenital heart disease (CHD). BST echocardiography was highly feasible, reproducible, and fast. High-frame rate BST provided complimentary information to conventional color-Doppler data enhancing the visualization and understanding of anomalous blood trajectories (eg, shunt direction, regurgitant volumes, and stenotic jets) and vortex formation. High-frame rate BST echocardiography is a new, promising imaging tool that may be helpful for deeper understanding of complex CHD physiology.
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Affiliation(s)
- Massimiliano Cantinotti
- Pediatric Cardiology and Cardiac Surgery, Stabilimento Ospedaliero di Massa Ospedale del Cuore G Pasquinucci, Massa, Toscana, USA.,Institute of Clinical Physiology (IFC), National Research Institute (CNR), Pisa, Italy
| | - Pietro Marchese
- Pediatric Cardiology and Cardiac Surgery, Stabilimento Ospedaliero di Massa Ospedale del Cuore G Pasquinucci, Massa, Toscana, USA.,Department of Pediatrics, University of Pisa, Pisa, Italy
| | - Martin Koestenberger
- Division of Pediatric Cardiology, Department of Pediatrics Medical University Graz, Graz, Austria
| | | | - Giuseppe Santoro
- Pediatric Cardiology and Cardiac Surgery, Stabilimento Ospedaliero di Massa Ospedale del Cuore G Pasquinucci, Massa, Toscana, USA
| | - Nadia Assanta
- Pediatric Cardiology and Cardiac Surgery, Stabilimento Ospedaliero di Massa Ospedale del Cuore G Pasquinucci, Massa, Toscana, USA
| | - Shelby Kutty
- Johns Hopkins Medicine, Pediatrics, Baltimore, MD, USA
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48
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Shekhar A, Aristizabal O, Fishman GI, Phoon CKL, Ketterling JA. Characterization of Vortex Flow in a Mouse Model of Ventricular Dyssynchrony by Plane-Wave Ultrasound Using Hexplex Processing. IEEE TRANSACTIONS ON ULTRASONICS, FERROELECTRICS, AND FREQUENCY CONTROL 2021; 68:538-548. [PMID: 32763851 PMCID: PMC8054309 DOI: 10.1109/tuffc.2020.3014844] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
The rodent heart is frequently used to study human cardiovascular disease (CVD). Although advanced cardiovascular ultrasound imaging methods are available for human clinical practice, application of these techniques to small animals remains limited due to the temporal and spatial-resolution demands. Here, an ultrasound vector-flow workflow is demonstrated that enables visualization and quantification of the complex hemodynamics within the mouse heart. Wild type (WT) and fibroblast growth factor homologous factor 2 (FHF2)-deficient mice (Fhf2 KO/Y ), which present with hyperthermia-induced ECG abnormalities highly reminiscent of Brugada syndrome, were used as a mouse model of human CVD. An 18-MHz linear array was used to acquire high-speed (30 kHz), plane-wave data of the left ventricle (LV) while increasing core body temperature up to 41.5 °C. Hexplex (i.e., six output) processing of the raw data sets produced the output of vector-flow estimates (magnitude and phase); B-mode and color-Doppler images; Doppler spectrograms; and local time histories of vorticity and pericardium motion. Fhf2 WT/Y mice had repeatable beat-to-beat cardiac function, including vortex formation during diastole, at all temperatures. In contrast, Fhf2 KO/Y mice displayed dyssynchronous contractile motion that disrupted normal inflow vortex formation and impaired LV filling as temperature rose. The hexplex processing approach demonstrates the ability to visualize and quantify the interplay between hemodynamic and mechanical function in a mouse model of human CVD.
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49
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Brum J, Bernal M, Barrere N, Negreira C, Cabeza C. Vortex dynamics and transport phenomena in stenotic aortic models using Echo-PIV. Phys Med Biol 2021; 66. [PMID: 33361564 DOI: 10.1088/1361-6560/abd670] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Accepted: 12/23/2020] [Indexed: 11/12/2022]
Abstract
Atherosclerosis is the most fatal cardiovascular disease. As disease progresses, stenoses grow inside the arteries blocking their lumen and altering blood flow. Analysing flow dynamics can provide a deeper insight on the stenosis evolution. In this work we combined Eulerian and Lagrangian descriptors to analyze blood flow dynamics and fluid transport in stenotic aortic models with morphology, mechanical and optical properties close to those of real arteries. To this end, vorticity, particle residence time (PRT), particle's final position (FP) and finite time Lyapunov's exponents (FTLE) were computed from the experimental fluid velocity fields acquired using ultrasonic particle imaging velocimetry (Echo-PIV). For the experiments, CT-images were used to create morphological realistic models of the descending aorta with 0%, 35% and 50% occlusion degree with same mechanical properties as real arteries. Each model was connected to a circuit with a pulsatile programmable pump which mimics physiological flow and pressure conditions. The pulsatile frequency was set to ≈0.9 Hz (55 bpm) and the upstream peak Reynolds number (Re) was changed from 1100 to 2000. Flow in the post-stenotic region was composed of two main structures: a high velocity jet over the stenosis throat and a recirculation region behind the stenosis where vortex form and shed. We characterized vortex kinematics showing that vortex propagation velocity increases withRe. Moreover, from the FTLE field we identified Lagrangian coherent structures (i.e. material barriers) that dictate transport behind the stenosis. The size and strength of those barriers increased withReand the occlusion degree. Finally, from the PRT and FP maps, we showed that independently ofRe, the same amount of fluid remains on the stenosis over more than a pulsatile period.
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Affiliation(s)
- Javier Brum
- Laboratorio de Acústica Ultrasonora, Instituto de Física, Facultad de Ciencias, Universidad de la República, Iguá 4225, 11400, Montevideo, Uruguay
| | - Miguel Bernal
- Grupo de Dinámica Cardiovascular, Universidad Pontificia Bolivariana, Medellín, Colombia
| | - Nicasio Barrere
- Grupo de Física No Lineal, Instituto de Física, Facultad de Ciencias, Universidad de la República, Iguá 4225, 11400, Montevideo, Uruguay
| | - Carlos Negreira
- Laboratorio de Acústica Ultrasonora, Instituto de Física, Facultad de Ciencias, Universidad de la República, Iguá 4225, 11400, Montevideo, Uruguay
| | - Cecilia Cabeza
- Grupo de Física No Lineal, Instituto de Física, Facultad de Ciencias, Universidad de la República, Iguá 4225, 11400, Montevideo, Uruguay
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50
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Petrescu A, D'hooge J, Voigt JU. Concepts and applications of ultrafast cardiac ultrasound imaging. Echocardiography 2021; 38:7-15. [PMID: 33471395 DOI: 10.1111/echo.14971] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Accepted: 12/22/2020] [Indexed: 12/20/2022] Open
Abstract
The concept of ultrafast echocardiographic imaging has been around for decades. However, only recent progress in ultrasound machine hardware and computer technology allowed to apply this concept to echocardiography. High frame rate echocardiography can visualize phenomena that have never been captured before. It enables a wide variety of potential new applications, including shear wave imaging, speckle tracking, ultrafast Doppler imaging, and myocardial perfusion imaging. The principles of these applications and their potential clinical use will be presented in this manuscript.
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Affiliation(s)
- Aniela Petrescu
- Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium.,Department of Cardiology, Heart Valve Center, University Medical Center Mainz, Mainz, Germany
| | - Jan D'hooge
- Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium
| | - Jens-Uwe Voigt
- Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium.,Department of Cardiovascular Diseases, University Hospitals Leuven, Leuven, Belgium
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